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Laser Treatments in phlebology

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.

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Laser Treatments in phlebology

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  1. Laser Treatments in phlebology Daniel Cassuto Milano, Prof. a C. Chirurgia Plastica Università di Catania

  2. Possible complications treatable by laser Tx • Surgical scars • Post skin necrosis • Matting • Post inflammatory hyperpigmentation • Allergic reactions to sclerotherapy

  3. Ingrandimento sotto illuminazione polarizzata Strutture superficiali Strutture epidermiche

  4. Polarized light viewer: Head rest • Light source Polaroid filters Magnifying lenses

  5. Normal view Polarized view

  6. Post 1

  7. After 5 sessions of LBO (scanned and 1000µ) at various fluences. 18 months follow up

  8. Pre post2 post3 post5

  9. Matting of the leg through normal magnifying illumination Matting of the leg through polarized light magnification

  10. Wavelengths used for leg veins • Visible (532,578, 585, 595, 600) • Infrared (755, 800-810, 940, 980, 1064) • Intense Pulsed Light (500-1200)

  11. Absorption curve of the main chromophores Absorption coefficient 500 750 1000 1250 Wavelength (nm)

  12. Selective photocoagulation

  13. Principles • Selective photocoagulation (not photothermolysis): longer pulses allow more thermal damage to vessel walls (methemoglobin?- Mordon S. et al. 2003) • Aggressive cooling allows skin protection • Both 1&2 protect darker skin types

  14. 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.

  15. Results: • Significant clearance (at least 66%) was obtained in 1.8 sessions in 85 % of patients. • The satisfaction was good in 95 % of patients.

  16. 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

  17. 1. MATTING F, 42 ys old.Rt lower lateral thigh matting532 nm, 500μ, ed 22.5 j/cm2, 2 treatments. Landmarks Landmarks

  18. 47 ys F. Matting lt calf1 pass, 532 nm, 1000 micron, 11 j\cm2, 6 Hz 1. MATTING – cont. Before After

  19. 2.SCARRING43 ys, F. - rt thigh Post sclerotherapy Before After

  20. 3.ALLERGY 33 ys old.Left popliteal area. 810 nm, 4mm, ed 90 j/cm2,1pass

  21. 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

  22. 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

  23. Prima Conclusioni: Dopo 3 trattamenti 532 nm, scanner, 3 msec • Indicazioni per laserterapia vascolare degli arti inferiori: • Assolute: • matting • “agofobia” • allergia • malformazioni capillari • angiomi • Relative: • vasi fra 0,7 mm e 1,5 mm: sclero-laserterapia combinata

  24. Thank you for your attention

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