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Use of the Er:YAG laser for improved plating in maxillofacial surgery: comparison of bone healing in laser and drill osteotomies.

BACKGROUND AND OBJECTIVE: Surgical reconstruction of bony defects in the maxillofacial region involves fixation of bony fragments with mini and micro plates. Bone stabilization during hole drilling is often challenging due to the need to apply pressure when using a conventional mechanical Hall drill. In addition, fragmentation of the fragile bones may occur and complicate the reconstruction. The pulsed Er:YAG laser offers an attractive alternative drilling modality because it does not require physical contact with the bone in order to drill holes, cuts bone with minimal thermal damage, and allows precise control of bone cutting. The objective of this study was to investigate the pulsed Er:YAG laser as an alternative to the mechanical bur by comparing bone healing using both modalities. STUDY DESIGN/MATERIALS AND METHODS: Bone healing in an inferior border defect of the rat mandible was examined using either an Er:YAG laser or a mechanical bur for drilling. The healing of osteotomies in facial bones and of screw holes for plate stabilization of free bone fragments was studied. RESULTS: All defects healed by 4 weeks postoperatively. Histologic evaluation demonstrated no difference in the amount of newly formed woven bone at the osteotomy site or screw holes made by either the laser or the drill. The extent of thermal damage at the osteotomy sites was comparable in laser and mechanically cut bone fragments. CONCLUSIONS: On the basis of this study we suggest that the Er: YAG laser can be used clinically in thin, fragile bones in the maxillofacial region.

Aluminum Silicates↗

Visual laser ablation of the canine prostate with a diffusing fiber and an 805-nanometer diode laser.

BACKGROUND AND OBJECTIVE: Although the popularity of visual laser ablation of the prostate (VLAP) as a treatment for symptomatic, benign prostatic hyperplasia (BPH) is increasing, the perceived advantages of VLAP over conventional transurethral electroresection of the prostate (TURP) is being debated because optimal technique and dosimetry for surgical lasers are still being refined. At this time, the 1.06 neodymium:yttrium-aluminum-garnet (Nd:YAG) laser and a laterally deflecting delivery system is the hardware combination most widely used for VLAP. STUDY DESIGN/MATERIALS AND METHODS: Reported here is a study of an alternate system, a 805-nm diode laser (Diomed 25 Diomedics, The Woodlands, TX) with a cylindrically diffusing fiber (Surgimedics Inc., The Woodlands, TX). Eight mongrel dogs were prostatectomized by transurethral irradiation of the prostate with 15,000 J of diode laser energy delivered via a fiber that diffuses the energy in a 1.5-cm-long cylindrical pattern. The dogs were sacrificed and prostates harvested at 3 hours and 1,4,7,14,21,35, and 49 days after the procedure, fixed with 10% buffered formalin, and examined histologically. RESULTS/CONCLUSIONS: It was found that this laser/fiber combination created volumes of tissue coagulation similar to those encountered in our previous work with the Nd:YAG laser in combination with both laterally deflecting and diffuser fibers, while offering the distinct advantages of simplified technique, lower cost hardware, and fewer postoperative complications in the dog model.

Animals↗

Gold vapor laser versus tunable argon-dye laser for endobronchial photodynamic therapy.

BACKGROUND AND OBJECTIVE: To compare the effectiveness of a gold vapor pulsed laser versus an argon dye continuous wave laser system in decreasing the amount of obstruction caused by endobronchial tumors when they are treated with photodynamic therapy (PDT). STUDY DESIGN/MATERIALS AND METHODS: The percentage of endobronchial obstruction from tumors before and at the end of PDT, and before and at the end of toilet bronchoscopy of 96 sites treated with light generated by a Spectra Physics tunable argon dye system were compared to those of 17 sites treated with light generated by a gold vapor laser. All patients were injected intravenously with 60 mg of dihematoporphyrin ethers per square meter of body surface. All treatments were done with a power density of 500 mW/CF and a light dose of 400 J/CF delivered from cylinder diffusing fibers. RESULTS: Paired Student's t-tests and Wilcoxon signed ranks tests showed significant decreases in the percentage of endobronchial obstruction due to PDT regardless of the laser used. Unpaired Student's t-tests and Mann-Whitney U statistical comparisons showed no significant difference between the two lasers in the percentage decrease at PDT, percentage increase from exudate seen at toilet bronchoscopy, nor the percentage decrease at the end of the toilet bronchoscopy from that before PDT. CONCLUSION: We found no statistically significant difference in the decrease in the amount of endobronchial tumor obstruction obtained when the light for treatment was generated by a pulsed gold vapor or a continuous wave argon dye laser system.

Antineoplastic Agents↗

Effect of nonablative laser energy on the joint capsule: an in vivo rabbit study using a holmium:YAG laser.

BACKGROUND AND OBJECTIVE: The nonablative application of holmium:yttrium-aluminum-garnet (Ho:YAG) laser energy to the joint capsule of patients with glenohumeral instability has been found to shrink capsular tissue and to help stabilize the joint. The purpose of this study was to evaluate the effect of nonablative laser energy on the short-term histological properties of joint capsular tissue in an in vivo rabbit model. STUDY DESIGN/MATERIALS AND METHODS: Eighteen mature New Zealand white rabbits were used in this study. One randomly selected stifle was treated with laser energy, and the contralateral stifle was sham-operated. Animals were euthanized immediately after surgery (day 0), at 7 days postsurgery and 30 days postsurgery. Specimens were processed for histology and transmission electron microscopy. RESULTS: Laser-treated samples at day 0 showed diffuse hyalinization of collagen with nuclear karyorrhexis of fibroblasts. Laser-treated tissue at 7 days postsurgery revealed fibroblast proliferation around and into acellular hyalinized regions of collagen. At 30 days postlaser treatment, areas of fused collagen were greatly reduced as large reactive fibroblasts migrated and secreted matrix. CONCLUSION: This study illustrates the short-term in vivo tissue response to nonablative laser treatment, where acellular hyalinized regions of collagen are infiltrated by fibroblasts that have used the treated collagen as the framework for migration and secretion of new collagen matrix in order for tissue repair to proceed.

Animals↗

Imaging of the irradiation of skin with a clinical CO2 laser system: implications for laser skin resurfacing.

BACKGROUND AND OBJECTIVE: Several published reports describe the benefits of using the carbon dioxide laser for cutaneous resurfacing. The mechanisms on which skin resurfacing work are still not completely understood. This study was performed to obtain quantitative and qualitative information describing the thermal response of skin during high-energy, short-pulsed CO2 laser irradiation. STUDY DESIGN/MATERIALS AND METHODS: A Tissue Technologies TruPulse CO2 laser was used to irradiate an in vivo rat model. The laser parameters that were used were a 100-micros pulse width, a 1-Hz repetition rate, a 3 mm x 3 mm square spot size, and 2.4 J/cm2 and 3.9 J/cm2 radiant exposures. A 3-5 microm thermal camera was used to obtain temperature information during irradiation. Single spots were irradiated with one pulse, and the temperature-time history was obtained. In a different experiment, 15 pulses were applied to single spots, and both thermal and video images were obtained. RESULTS: Irradiation with one pulse at 2.4 J/cm2 and 3.9 J/cm2 led to peak temperatures >100 degrees C. The temperature relaxation time was approximately 25-150 ms. Multiple-pulse irradiation at 2.4 J/cm2 led to a slight rise in the peak temperature with each pulse. At 3.9 J/cm2, the peak temperature increased with successive pulses until pulse 10, after which the peak temperature oscillated between 300 and 400 degrees C. Video images showed concurrent burning events that occurred during pulses 10-15. CONCLUSION: Temperatures >100 degrees C were measured during CO2 laser irradiation of skin. Pulse stacking can lead to peak temperatures approaching 400 degrees C and to tissue charring with as few as three stacked pulses. It is crucial for the physician to manipulate the laser handpiece at parameters with which he or she can avoid pulse overlap.

Animals↗

In vitro laser ablation of laboratory developed biofilms using an Nd:YAG laser of 532 nm wavelength.

We studied the laser ablation of laboratory-developed biofilm on titanium and glass surfaces. Specifically, Pseudoalteromonas carrageenovora, a marine biofilm forming bacterium was used to generate laboratory biofilm. Two fluences, 0.05 and 0.1 J/cm(2) and three durations of irradiation, 30 s, 5 min, and 10 min were tested using an Nd;YAG laser of 532 nm wavelength (in the green light area). Nonirradiated coupons with biofilm served as control. The biofilm removal efficiency increased with the increase in laser fluence and duration of irradiation. The maximum biofilm area cover on control coupons of glass and titanium was 62.5 and 76.0%, respectively. Upon irradiation with fluence 0.1 J/cm(2) for the very short duration of 30 s, this reduced to 5.6 and 12.4% and at 10 min to 2.17 and 0.7% on glass and titanium coupons, respectively, while the controls did not show any reductions (62.5 and 76.0% respectively, for glass and titanium coupons). The biofilm TRC (Total Resuscitated Cells) reduction during this period was even more prominent than the area cover, indicating that the remaining biofilm portions on coupons after irradiation were largely composed of dead bacterial cells. The TRC in the irradiation chamber medium for short durations of irradiation showed a significant increase, indicating that the laser irradiation removed live bacteria from the biofilm. The re-growth of the resuscitated cells showed they could grow like the control cells but with a significant lag. The laser's efficiency in the removal of biofilm was better seen on titanium coupons than on glass. Our results showed that a low-power pulsed laser irradiation could be used to remove biofilm formed on hard surfaces.

Biofilms↗

Peripheral percutaneous transluminal laser angioplasty in humans: in vitro investigations and clinical results with a novel laser catheter system.

Percutaneous transluminal laser angioplasty has become an accepted method of treatment of peripheral arterial occlusive disease. To minimize the risk of arterial wall perforation during laser angioplasty, a novel laser catheter system was developed. In 113 obliterated postmortem human arteries the perforation rate was 0.9%. The mean degree of stenosis was reduced from 89 +/- 9% before, to 53 +/- 11% after laser irradiation. Clinical Nd:YAG laser angioplasty was performed in 19 patients suffering from peripheral arterial occlusive disease. The Fontaine stage improved in 16 patients; in no case did it deteriorate. The mean degree of stenosis was reduced by laser angioplasty from 91 +/- 12% to 31 +/- 19%. A further reduction down to 13 +/- 18% was achieved by subsequent percutaneous transluminal balloon angioplasty. The systolic Doppler ankle-arm pressure gradient was improved from 0.58 +/- 0.26 to 0.89 +/- 0.25. In 7 patients microembolisms were detectable on the final angiogram. There was no acute reocclusion and no perforation. Within a follow-up period of 12 months, four restenoses were diagnosed by digital subtraction angiography. On average, the Doppler index was 0.75 +/- 0.32.

Angioplasty, Balloon↗

Non-ablative laser treatment of facial rhytides: a comparison of 1450-nm diode laser treatment with dynamic cooling as opposed to treatment with dynamic cooling alone.

BACKGROUND AND OBJECTIVE: Non-ablative dermal remodeling has been shown to create new dermal collagen. This is thought to occur secondary to a laser-induced injury to the skin. Other mechanisms of injury may lead to similar results. The aim of this study was to evaluate the efficacy and complication rate of a 1450-nm diode laser and compare clinical effect when the laser is used in conjunction with cryogen cooling as compared to the use of cryogen cooling alone. STUDY DESIGN/MATERIALS AND METHODS: Twenty subjects, skin types I-IV, age range 42-70 years, with Class I and II rhytides were enrolled in the study. Subjects were treated with 2-4 laser treatments and cryogen cooling on one side of their face, while the contralateral side was treated with cryogen cooling alone. Subjects were evaluated six months after their final treatment. RESULTS: Thirteen subjects showed clinical improvement on the laser/cryogen treated side. No subjects were noted to have any improvement at the cryogen alone side. CONCLUSION: The 1450-nm diode laser can lead to non-ablative improvement of rhytides. This effect appears to be a direct laser induced effect.

Adult↗

Vascular response to laser photothermolysis as a function of pulse duration, vessel type, and diameter: implications for port wine stain laser therapy.

BACKGROUND AND OBJECTIVE: Treatment of port wine stains (PWS) by photothermolysis can be improved by optimizing laser parameters on an individual patient basis. We have studied the critical role of pulse duration (t(p)) on the treatment efficacy. STUDY DESIGN/MATERIALS AND METHODS: The V-beam laser (Candela) allowed changing t(p) over user-specified discrete values between 1.5 and 40 milliseconds by delivering a series of 100 microsecond spikes. For the 1.5 and 3 millisecond pulses, three spikes were observed at intervals t(p)/2 and for t(p)> or =6 milliseconds, four spikes separated by t(p)/3. The ScleroPlus laser (Candela) has a smooth output over its fixed 1.5 milliseconds duration. Blood vessels in the chick chorioallantoic membrane (CAM) were irradiated at fixed wavelength (595 nm), spot size (7 mm), radiant exposure (15 Jcm(-2)), and at variable t(p). The CAM contains an extensive microvascular network ranging from capillaries with diameter D<30 microm to blood vessels of D approximately 120 microm. The CAM assay allows real-time video documentation, and observation of blood flow in pre-capillary arterioles (A) and post-capillary venules (V). Vessel injury was graded from recorded videotapes. Mathematical modeling was developed to interpret results of vessel injury when varying t(p) and D. A modified thermal relaxation time was introduced to calculate vessel wall temperature following laser exposure. RESULTS: Arterioles. For increasing t(p), overall damage was found to decrease. For fixed t(p), damage decreased with vessel size. Venules. For all D, damage was smaller than for corresponding arterioles. There was no dependence of damage on t(p). For given t(p), no variation of damage with D was observed. Photothermolysis due to spiked (V-beam) vs. smooth (Scleroplus) delivery of laser energy at fixed t(p) (1.5 milliseconds), showed similar vessel injuries for al values of D (P>0.05). CONCLUSIONS: The difference between initial arteriole and venule damage could be explained by the threefold higher absorption coefficient at 595 nm in (oxygen-poor!) arterioles. In human patients, PWS consist of ectatic venules (characterized by higher absorption), so that these considerations favor the use of 595-nm irradiation for laser photothermolysis. For optimal treatment of PWS it is proposed that t(p) be between 0.1 and 1.5 milliseconds. This is based on a modified relaxation time tau'(d), defined as the time required for heat conduction into the full thickness of the vessel wall, which is assumed to have a thickness DeltaD approximately 0.1D. The corresponding tau'(d) will be a factor of about six smaller than given in the literature. For vessels with D between 30 and 300 mum, tau'(d) ranges from 0.1 to 1.5 milliseconds.

Humans↗

Acute ultrastructural changes of the trabecular meshwork after selective laser trabeculoplasty and low power argon laser trabeculoplasty.

BACKGROUND AND OBJECTIVES: To compare the histopathological changes in the human trabecular meshwork after low power argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) with a Q-switched, frequency-doubled, neodymium:yttrium-aluminium-garnet (Nd:YAG) laser. STUDY DESIGN/MATERIALS AND METHODS: In gonioscopically normal trabecular meshwork of three patients awaiting enucleation due to malignant melanoma of the choroid, SLT and ALT were performed 1-5 days prior to enucleation. In each eye, the lower half of trabecular meshwork received SLT, one quadrant low power (460 mW) ALT and one quadrant was left untreated. Specimens were evaluated with light and transmission electron microscopy. RESULTS: A sharp demarcation line was visible between the laser treated and untreated intact trabecular meshwork after ALT and SLT. Both lasers caused disruption of trabecular beams, but the extent of the damage was smaller after SLT. The collagen component of trabecular beams was mostly amorphous, the long-spacing collagen was scanty after ALT, but more abundant after SLT. In the intertrabecular spaces fragmented cells and tissue debris with only a few pigmented cells were observed. Some endothelial cells were desquamated, but appeared slightly better preserved after SLT than ALT. CONCLUSIONS: Our ultrastructural comparison of the morphological changes after low power ALT and SLT in patients demonstrated that both lasers caused splitting and fragmentation of the trabecular beams of the trabecular meshwork, but the extent of the damage was smaller and the preservation of long-spacing collagen better after SLT than after ALT.

Argon↗

Laser assisted skin closure (LASC) by using a 815-nm diode-laser system accelerates and improves wound healing.

BACKGROUND AND OBJECTIVE: This study aimed to evaluate a 815-nm diode-laser system to assist wound closure to accelerate and improve healing process. STUDY DESIGN/MATERIALS AND METHODS: A total of 25 male hairless rats (mutant OFA Sprague-Dawley rats, IFFA-CREDO, L'Arbresle, France) with four dorsal skin incisions were used for the study. For each wound, the good apposition of the edges was obtained with buried absorbable suture. In the laser group, the laser beam was applied spot by spot through a transparent adhesive dressing along two incisions with the following parameters: 1.5 W; 3 seconds; spot diameter, 2 mm; fluence, 145 J/cm(2). Both control wounds were closed with conventional suture techniques. The duration of the closure procedure was noted for each group. Clinical examination, histologic study, and measurement of tensile strength were performed at 3, 7, 15, and 21 days after surgery. Determination of activation of heat shock protein 70 (Hsp70) through immunocytochemistry was performed at days 1 and 7. RESULTS: LASC was 4 times faster to process than conventional suture: 1 minute 49 +/- 20.6 seconds vs. 7 minutes 26 +/- 62.2 seconds. In the laser group, healing was accelerated resulting in a more indiscernible scar than in the control groups. Histologic aspect was better with earlier continuous epidermis and dermis and a thinner resulting scar. Tensile strength was 30 to 58% greater than in control groups at 7 and 15 days (P < 0.001). Expression of Hsp70 was markedly induced in skin structures examined after laser exposure. CONCLUSIONS: This study shows the ability of the 815-nm diode-laser system to assist wound closure leading to an acceleration and an improvement of wound healing with indiscernible resulting scar. The mechanisms of this phenomenon are still unclear but further investigations are in progress to attempt to explain them.

Animals↗

Vascular recanalization with the argon laser: the role of blood in the transmission of laser energy.

Successful revascularization of stenosed arteries with the argon laser optical fiber catheter requires delivery of high-power-density energy to the lesion. Because of the high energy absorption by hemoglobin at the argon laser wavelengths, which would attenuate transmission of laser energy to the obstruction, we measured argon laser transmission through blood at different concentrations. We found that no transmission occurred through 1 mm of whole blood with hematocrit of 42 and that blood must be diluted to a hematocrit below 1 for laser energy to be delivered. Successful use of the intravascular argon laser is dependent on the creation of a transmission medium by displacement of blood by saline or other non-absorbing substance.

Arterial Occlusive Diseases↗

The influence of hands-on laser training on usage of the CO2 laser.

A questionnaire was distributed to all participants in the Rochester General Hospital CO2 laser training workshops for surgeons (1982 to January 1985). The results of this study indicate that, while laser training is necessary prior to being able to use the laser, only a small fraction of trainees actually use the laser in their clinical practice. Surgeons who are using the laser do so in a minority of their cases. New incentives for laser usage must be investigated.

Education, Medical, Continuing↗

Comparison of different lasers in terms of thrombogenicity of the laser-treated vascular wall.

The thrombogenic properties of the laser-treated vascular wall are reported as quantitatively assessed on the basis of 33 experiments with peripheral canine vessel segments. Three types of surfaces, namely, 1) intact, 2) mechanically de-endothelized, and 3) postlaser, have been simultaneously exposed to platelet-enriched plasma in a sequentially organized artificial circulation system. Then the adherent platelets have been counted on the treated surfaces, and the relative thrombogenicity index has been calculated according to the equation T = (A1 - Aint)/(Ad - Aint), where Aint, Ad, A1 = the adherent platelet counts on intact, mechanically de-endothelized, and laser-treated surfaces, respectively. The following lasers have been evaluated: 1) Nd-YAG, 1,060 nm, continuous wave, 4W; 2) argon-ion, 480 and 514 nm and argon-ion, 350 nm, continuous-wave, 1 W and 400 mW [corrected], respectively; 3) excimer XeCl, 308 nm, pulsed, 30 mJ per pulse, repetition rate 10 Hz [corrected]; and also 4) the laser-heated metal probe (2 mm diameter, Trimedyne, Nd-YAG) 1,060 nm, 8 W. The thrombogenicity index values obtained were 83 +/- 7, 72 +/- 8, 57 +/- 9, 63 +/- 7, and 82 +/- 9%, respectively. The differences between these values were statistically insignificant. The data are suggestive of the essential requirement of, at least, anticoagulant therapy after laser angioplasty irrespective of the laser type.

Animals↗

Comparison of local tumor recurrence following excision with the CO2 laser, Nd:YAG laser, and Argon Beam Coagulator.

This study compares the incidence of local tumor recurrence following primary excision with the CO2 laser, Nd:YAG laser (contact), Argon Beam Coagulator, or electrocautery. One hundred eight Fisher 344 rats with R3230AC mammary tumors (1.6 +/- 0.04 [SD] cm diameter) were used. All animals were randomized into groups of similar tumor size. In groups C and CS, excision was performed with a Sharplan 1060 CO2 laser (TEMoo, 25 W, continuous wave [CW], 0.2-mm spot size). Wounds in group CS were "sterilized" (0.5-mm spot size, 25 W, CW) by gently heating the wound without causing blanching or charring. In group N, a 0.4-mm contact Laser Blade and a Cooper 8000 Nd:YAG laser at 20 W CW was used. In groups SA1 and SA2, tumors were excised with the scalpel, and hemostasis and wound "sterilization" were accomplished with the Bard System 6000 Argon Beam Coagulator (ABC) at 40 W and 4 liters/min argon gas flow in SA1 and 12 liters/min in SA2. In group E, excision was accomplished at 40 W blend mode, 10 W spray mode. In group EA, excision was accomplished at 60 W cutting current, and hemostasis was achieved with the ABC. The animals were examined for evidence of recurrence for 34 days postoperatively. Mortalities were excluded from analysis. The incidence of recurrence was 11/14 (79%) in C, 6/16 (38%) in CS, 10/14 (71%) in SA1, 6/13 (46%) in SA2, 6/15 (40%) in N, 7/10 (70%) in EA, and 3/15 (20%) in E. Group E is statistically different (P less than .01) from groups EA, C, and SA1. Group C was different (P less than .01) from groups E, CS, and N. These results demonstrate an inverse relationship between tumor recurrence and local thermal effects at the surgical site. The ABC did not increase tumor recurrence. Contact YAG surgery was similar to CO2 laser excision and "sterilization." An attempt to study the influence of gas flow and pressure on local tumor recurrence and metastases should be made.

Adenocarcinoma↗

Mid-infrared erbium:YAG laser ablation of bone: the effect of laser osteotomy on bone healing.

A comparative study was undertaken in rabbit tibiae to assess the healing of bone in response to osteotomies by a mid-infrared erbium: YAG (2.94 microns) laser or a mechanical saw. Laser parameters necessary for osteotomy were shown to produce deep cuts with sharp edges and no gross charring or burning of adjacent bone. However, it was noted histologically that there was a delay in healing of the laser osteotomies as compared to saw osteotomies. This delay was caused by a microscopic zone of damage to bone adjacent to the laser cuts. It is concluded that, although the erbium: YAG laser may be a useful tool in orthopaedic surgery to ablate bone, under the conditions used in this study, there will be a delay in the healing process after laser osteotomy.

Animals↗

Disparate absorption of argon laser radiation by fibrous versus fatty plaque: implications for laser angioplasty.

The thermal response of white fibrous atheromatous plaque to argon laser irradiation was compared with the thermal response of yellow fatty plaque and normal aortic wall to the same type of radiation. Samples of normal aorta, fibrous, and fatty plaque were irradiated in air with 3.5 Watts of laser power on a 2 mm spot for 5 and 10 seconds. Heterogeneous foci, each covering normal aorta and either fibrous or fatty plaque, were additionally irradiated with 7 Watts on a 1 cm spot for 30 seconds to 2.5 minutes. Tissue surface temperature was monitored during laser irradiation via a 3-5 micron infrared camera. For the 2 mm spot and 5 second exposure time, argon laser irradiation of normal aorta produced popping and surface tearing at a peak temperature of 145 +/- 10 degrees C. Irradiation of fatty plaque produced popping and crater formation at a peak temperature of 200 +/- 10 degrees C. However, fibrous plaque was nonablatively discolored by the same dose of laser radiation with a peak temperature of only 85 +/- 10 degrees C. Irradiation for 10 seconds caused crater formation and carbonization in the fatty plaque but failed to produce ablation in the fibrous plaque. Irradiation of the heterogeneous foci confirmed the disparity in the temperature attained by these two types of plaque and their degree of damage. Therefore, this study suggests that the ablation threshold for soft atheroma is strongly dependent on the optical properties of the particular type of tissue. Yellow fatty plaque preferentially absorbs argon laser radiation, but white fibrous plaque absorbs this radiation less readily than normal aortic wall.

Angioplasty, Balloon↗

Pigmentation-dependent side effects to copper vapor laser and argon laser treatment.

BACKGROUND AND OBJECTIVE: Melanin is a limiting factor for obtaining beneficial results in dermatological treatment of vascular malformations. The aim of our study was to establish a relation between pretreatment skin pigmentation and the occurrence of side effects. STUDY DESIGN/MATERIALS AND METHODS: Thirteen human volunteers selected to have a varying degree of skin pigmentation were laser-treated on the inside of the brachium with an argon laser (AL, 488 nm and 514.5 nm) and a copper vapor laser (CVL, 578 nm), both connected to a Hexascan. Total exposure areas were 1.26 cm2 and beam diameters were 1 mm. Three intensities were used, 0.7, 1.0, and 1.3 W. Pulse duration was 200 ms, resulting in fluences of 17.8, 25.5, and 33.1 J/cm2. Pretreatment skin pigmentation was objectified by skin reflectance measurements. RESULTS: At 1, 2, and 6 months after laser treatment, significant correlations were demonstrated between pretreatment skin pigmentation and laser-induced pigmentary changes and scar formation. At the 6-month assessment, the AL induced significantly higher scores of clinically evaluated scar formation as compared with the CVL (1.0 and 1.3 W/spot) and tended to induce higher clinical scores of pigmentary changes (not significant, ns). CONCLUSIONS: We recommend skin pigmentation to be taken into consideration in dermatological laser treatment of vascular malformations.

Adult↗