Treatment of venous lesions of the lips and perioral area with a long-pulsed Nd:YAG laser.

The conventional treatments for venous lesions of the lip have been excision, cryotherapy, infrared coagulation, and sclerotherapy. We report the use of a long-pulsed Nd:YAG laser in 31 consecutive patients. At a mean follow up of 12 months (6 weeks to 3 years), 27 (87%) had no evidence of recurrence and one had a small contracted scar. The treatment is effective for both small and large lesions, and operation or other ablative techniques are no longer indicated, or considerably less relevant.

Intraoral flap depilation using the long-pulsed alexandrite laser.

A multitude of skin flaps are used to reconstruct defects following the surgical resection of head and neck cancers. Skin imported from distant sites to provide intraoral coverage often contains hair-bearing skin, which can create a problem following reconstruction of the oropharynx. Patients with hairy intraoral flaps often present with irritation, pooling of saliva and trapping of food. In this article, we report, for the first time, a treatment for the removal of hair from intraoral flaps using a long-pulsed alexandrite laser.

Laser depilation and hygiene: preventing recurrent pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease of the natal cleft is a painful and debilitating condition which often recurs despite multiple surgical undertakings. We describe the long pulsed alexandrite laser for hair depilation and the role of personal hygiene, which is often overlooked when treating this disease, as an adjunct to preventing recurrent pilonidal sinus disease. METHODS: A review of 14 patients who underwent laser hair depilation in the natal cleft following pilonidal sinus surgery. The majority of patients had recurrent disease and had undergone numerous surgical procedures (range 1-5, mean 2.07) All patients were given advice regarding meticulous personal hygiene at the time of consultation. RESULTS: 12 patients received the full course of treatment (three treatments, 6-weekly) followed by 'top-up' treatments as required (mean number of treatments 3.9). None of the patients developed recurrent disease at 1-year follow up and, to date, none have required further surgery. CONCLUSION: Laser hair depilation is a useful adjunct in preventing the recurrence of pilonidal sinus disease and should be offered routinely to all patients. This coupled with patient education regarding personal hygiene reduces the risk of developing recurrent pilonidal sinus disease.

Combined early treatment of congenital melanocytic naevus with carbon dioxide and NdYag lasers.

Three cases of extensive congenital melanocytic naevi were treated with a combined approach using a ultrapulse carbon dioxide laser and a Nd Yag laser within 1 year of birth. The naevi were substantially depigmented and this result has been maintained for up to 36 months following treatment. The condition, treatment and the relevant literature are discussed.

Granuloma annulare in the hand.

A review of our cases of granuloma annulare in the hand revealed that it presented as either an annular or subcutaneous lesion, most commonly on the dorsum of the metacarpophalangeal joint of the middle or ring fingers. Lesions were approximately 10 mm in diameter and the diagnosis was confirmed by surgical biopsy. The majority of cases resolved spontaneously within 1 year, and recurrence, though common, did not necessitate a further biopsy.

The re-attachment of tendon and ligament avulsions.

This paper presents our experience of a new technique for the reattachment of tendons in the hand. A percutaneous Kirschner wire is fashioned into a hoop to support an intratendinous suture. This mechanism maintains continuous traction upon the avulsed tendon. The technique avoids extensive dissection of the fingertip and the direct application of pressure on the dorsal surface of the digit, which might cause skin breakdown.

The control of fire hazard during cutaneous laser therapy.

This article reviews the literature on fire hazard relating to the laser treatment of cutaneous conditions and collates recommended precautions. Further suggestions are added.

Pilonidal sinus of the finger pulp.

A case of pilonidal sinus of the finger-tip pulp in a male barber is reported. The site appears to be previously unreported for this condition.

Ulnar tunnel syndrome--an unusual cause.

We describe a case of anomalous muscle belly at Guyon's canal causing ulnar tunnel syndrome with sparing of the motor branch and hypothenar muscles.

The treatment of early cutaneous capillary haemangiomata (strawberry naevi) with the tunable dye laser.

We have treated 39 early cutaneous capillary haemangiomata, in 24 infants, with the tunable dye laser at a wavelength of 585 nm (SPTL 1b, Candela Corporation, Wayland, MA, USA). The average age at first treatment was 13 weeks. The first signs of involution were seen at 19 weeks of age. Complete resolution of the lesions was seen in 61. 5% of haemangiomata at an average age of 39 weeks. Two haemangiomata did not respond to laser treatment and were treated successfully with intralesional steroid injection. There were no complications of laser treatment. The natural history of the treated haemangiomata was significantly shorter than historical evidence suggests for untreated lesions. Haemangiomata may be treated safely and effectively with the tunable dye laser in the early weeks of life leading to accelerated involution and resolution.

Cutaneous lesions in hereditary haemorrhagic telangiectasia: successful treatment with the tunable dye laser.

BACKGROUND: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant inherited condition that has cutaneous telangiectasia as a component of its manifestations. It has been found that the tunable dye laser is effective in the clearance of these lesions. METHODS: Twelve patients with HHT between 1991 and 1999 were treated with the tunable dye laser. Treatment was carried out at 3-month intervals. RESULTS: Of the 12 patients treated with the tunable dye laser, 10 were evaluated after treatment. In all cases, the cutaneous component had resolved. CONCLUSION: The diagnosis of HHT should be considered in all cases of telangiectatic skin lesions. The tunable dye laser appears to be an effective means of resolving any cosmetic problems.

Treatment of traumatic tattoos with the Nd YAG laser: a series of nine cases.

Inadequate primary skin cleansing for dirt-ingrained skin abrasions can result in disfiguring traumatic tattoos. We present nine cases of traumatic tattoos treated with the Nd YAG laser. In six cases the pigmentation was completely cleared and in three cases minimal pigmentation remained. The Nd YAG laser offers effective late treatment of traumatic tattoos with many advantages over conventional destructive treatment modalities. The best treatment is still immediate debridement and cleaning.

Fingertip reconstruction with a dorsal island homodigital flap.

A distal dorsal island homodigital flap has been used for reconstruction of fingertips in nine patients who sustained traumatic amputations either obliquely or transversely through the middle of the distal phalanx. Seven of the nine patients attended for follow-up. All the flaps survived with the exception of a small area of partial necrosis in one patient. Fingertip reconstruction with this flap is a one-stage procedure, safe, easy to perform and provides durable tissue support for the nail to regrow undeformed.