laser transdermico

Laser Treatments in
phlebology
Daniel Cassuto
Milano,
Prof. a C. Chirurgia Plastica
Università di Catania
Possible complications treatable by
laser Tx
Surgical scars
Post skin necrosis
Matting
Post inflammatory hyperpigmentation
Allergic reactions to sclerotherapy
Ingrandimento sotto illuminazione polarizzata
Strutture superficiali
Strutture epidermiche
Polarized light viewer:
Light source
Polaroid filters
Magnifying
lenses
Head rest
Normal view
Polarized view
Post 1
After 5 sessions of LBO (scanned
and 1000µ) at various fluences.
18 months follow up
Pre
post3
post2
post5
Matting of the leg
through normal
magnifying illumination
Matting of the leg
through polarized light
magnification
Wavelengths used for leg veins
Visible (532, 578, 585, 595, 600)
Infrared (755, 800-810, 940, 980, 1064)
Intense Pulsed Light (500-1200)
Absorption coefficient
Absorption curve of the main chromophores
500
750
Wavelength (nm)
1000
1250
Selective photocoagulation
Principles
1.
Selective photocoagulation (not
photothermolysis): longer pulses allow more
thermal damage to vessel walls
(methemoglobin?- Mordon S. et al. 2003)
2.
Aggressive cooling allows skin protection
3.
Both 1&2 protect darker skin types
Materials and methods:
20 consecutive female patients with:
– class I-III red telangiectasias,
– blue venulectasias
– reticular veins were treated with a combination of 532 nm (1000μ, 9-12
j/cm2) and 810nm (4mm, 80-90 j/cm2 ) lasers.
Patients with significant venous circulatory impairment were
excluded.
Both treatments were applied with contact skin cooling.
The results were examined by digital macrophotographic
imaging and a patient evaluation scale.
% of Vessel Clearance
82
80
78
Results:
%
76
Red
Blue
Purple
74
72
70
68
66
Colour
Significant clearance (at least 66%) was obtained in
1.8 sessions in 85 % of patients.
The satisfaction was good in 95 % of patients.
Teleangectasie degli arti
inferiori:
principi di laser-Tx
•Inquadramento flebologico
•Scleroterapia dei vasi iniettabili
•Prevenzione (Reflusso, abuso di UV, moto, calze)
•Visione (luce polarizzata)
•Raffreddamento cutaneo
1. MATTING
F, 42 ys old.
Rt lower lateral thigh matting
532 nm, 500μ, ed 22.5 j/cm2, 2
treatments.
Landmarks
Landmarks
1. MATTING – cont.
47 ys F. Matting lt calf
1 pass, 532 nm, 1000 micron, 11 j\cm2, 6 Hz
Before
After
2.SCARRING
43 ys, F. - rt thigh
Post sclerotherapy
Before
After
3.ALLERGY
33 ys old.Left popliteal area. 810 nm, 4mm, ed 90 j/cm2,1pass
21.11.2001
Landmark*
Case description: Lt popliteal area
(i.e. back of the knee) of a 56 ys old
woman with varices. (The rt leg has
also been treated later and you’ll get
the pictures in a few weeks).
Parameters: 800 nm ed 45 j/cm2, 50
msec, 1 Hz, chilled tip, 1 session.
Treatment: slight pressure on the
skin with the handpiece. Treat until
the vein shrinks and disappears
within a few seconds. Stop before
you see the skin turning grayish:
that’s a burn. 10-20 days after
treatment the veins are still present
and full of coagulated blood, that I
remove by squeezing it through
small punctures in the skin and vein
wall that are absolutely painless.
This patient only used a mild cream
after treatment: no bandages,
compressive stockings nor activity
limitations were adopted.
*The preexisting little white scar is shown as a
landmark
23.1..2002
24 ys old women, 2 ys after RA with multiple trauma and multiple orthopedic procedures
including scar revisions.
2 months after:
• 5 monthly Tx with LBO 532nm,
scanner, 2.5 msec, 5W.
• Daily use of silicon sheath 2 mm
Conclusioni:
Indicazioni per laserterapia vascolare degli arti inferiori:
 Assolute:
Prima
 matting
“agofobia”
 allergia
 malformazioni capillari
 angiomi
 Relative:
 vasi fra 0,7 mm e 1,5 mm:
Dopo 3 trattamenti
532 nm, scanner, 3 msec
sclero-laserterapia combinata
Thank you for your attention