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Minimizing Epidermal Damage In Laser Coagulation Of Superficial Blood Vessels

Laser surgery has become the most frequently used treatment for cutaneous vascular malformations. Unfortunately, using the continuous wave lasers such as the argon and argon tunable dye lasers has resulted in a fairly high risk of scarring, ranging from 5-30% compared to the pulsed light from the flashlamp-pumped dye laser. The flashlamp-pumped dye laser was designed to coagulate vessels about 100 microns in diameter. It is not effective in closing vessels much larger than this. For this reason it is important to have a modality that makes the closure of larger vessels possible without scarring. It is possible to minimize epidermal temperature rise in response to continuous wave light application by the use of a 100 micron spot size focused on the vessel tissue which will restrict coagulation to the vessels. Skin surface temperatures were measured using a thermocouple. When coherent light was delivered from an argon (514 nm) and argon tunable dye (577 nm) lasers, a 100 micron spot power of 0.1 watt and one second exposures were used, the mean skin surface temperature rise was 6 ± 2 degrees celsius. By contrast, a 1000 micron spot, power of 1 watt and one second exposure resulted in a mean temperature rise of 20 ± 2 degrees celsius. These measurements were confirmed using an Inframetrics thermal camera. Treatment of portwine stains using this technique has substantially reduced the incidence of post-laser scarring.