ABSTRACT
BACKGROUND AND OBJECTIVES: The advantages of the continuous wave (c.w.) CO(2) laser are offset by the delay in laser wound healing secondary to thermal damage. We have developed novel heat-conducting templates to reduce laser thermal damage. Because shortened pulse durations also decrease thermal damage, we tested the effectiveness of heat-conducting templates with a c.w. CO(2) clinical laser and a short-pulsed CO(2) laser to determine the best method and mechanism to minimize thermal damage. STUDY DESIGN/MATERIALS AND METHODS: Comparison of 0.2-second shuttered c.w. and 5-microsecond pulsed CO(2) lasers were made by doing incisions on 150 tissue samples from reduction mammoplasties and abdominoplasties. Copper, aluminum, glass, and Plexiglass heat-conducting templates were tested against no template (air) with both lasers. Histological samples were evaluated using computerized morphometrics analysis. RESULTS: Statistically significant reductions in lateral thermal damage were seen with the copper (50%) and aluminum (39%) templates used with the c.w. CO(2) laser. Only the copper template (39%) significantly reduced thermal damage when used with the pulsed CO(2) laser. Less thermal damage was seen using the pulsed CO(2) laser compared to the c.w. CO(2) laser with each template. CONCLUSIONS: Heat-conducting templates significantly reduced the amount of lateral thermal damage when used with the c.w. CO(2) laser (copper and aluminum) and short-pulsed CO(2) laser (copper). The c.w. CO(2) laser with the copper template compared favorably to the short-pulsed CO(2) laser without a template. Therefore, both heat conductive templates and short-pulse structure provide successful methods for reducing lateral thermal damage, and a combination of the two appears to provide optimal results.
Subject(s)
Burns/prevention & control , Hot Temperature/adverse effects , Laser Therapy/methods , Skin/injuries , Skin/radiation effects , Aluminum , Burns/etiology , Burns/physiopathology , Carbon Dioxide , Copper , Data Interpretation, Statistical , Humans , In Vitro Techniques , Laser Therapy/adverse effects , Skin Temperature/radiation effects , Wound Healing/physiologyABSTRACT
BACKGROUND AND OBJECTIVES: We developed novel heat-conducting templates, and tested whether they could effectively remove damaging heat from the tissue during laser ablation. The reduction of lateral thermal damage during cutaneous incisional laser procedures should decrease the time in wound healing. In addition, we selected various infrared wavelengths to determine whether the template effects would be influenced by the laser penetration depth and the particular chromophore absorbing the laser light. STUDY DESIGN/MATERIALS AND METHODS: This study utilized the Free-Electron Laser at wavelengths of 3.0, 5.5, 6.45, 7.5, and 7.7 microm to produce 1.0 cm incisions on in vitro lightly pigmented human skin. At each of these wavelengths, copper, aluminum, glass, and Plexiglas heat conducting templates were tested. At wavelength 5.5 microm, the study was duplicated using in vitro darkly pigmented skin. Histological samples were evaluated using computerized morphometric analysis. RESULTS: The adjunct use of both the copper and aluminum templates provided a decrease in thermal damage at each wavelength. Using the copper template reduced lateral thermal damage an average of 67% with no apparent wavelength dependence. The aluminum template reduced thermal damage an average of 54% with no apparent wavelength dependence. The glass and Plexiglas templates did not reduce the lateral thermal damage. At 5.5 microm, no statistically significant difference in lateral thermal damage was observed between darkly and lightly pigmented tissues. CONCLUSIONS: Heat-conducting templates are an effective new method to reduce lateral thermal damage from thermal laser incisions.