Laser Treatments in Laser Treatments in phlebologyphlebology
Daniel CassutoDaniel CassutoMilano,Milano,
Prof. a C. Chirurgia PlasticaProf. a C. Chirurgia Plastica
Università di CataniaUniversità di Catania
Possible complications treatable by Possible complications treatable by laser Txlaser Tx
Surgical scarsSurgical scars
Post skin necrosisPost skin necrosis
MattingMatting
Post inflammatory hyperpigmentationPost inflammatory hyperpigmentation
Allergic reactions to sclerotherapyAllergic reactions to sclerotherapy
Ingrandimento sotto illuminazione Ingrandimento sotto illuminazione
polarizzatapolarizzata
Strutture superficiali Strutture superficiali
Strutture epidermicheStrutture epidermiche
Polarized light viewer:Polarized light viewer:Light sourceLight 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 post2
post3 post5
Matting of the leg through normal magnifying illumination
Matting of the leg through polarized light magnification
Wavelengths used for leg veinsWavelengths used for leg veins
Visible (Visible (532532,, 578578, 585, 595, 600), 585, 595, 600)
Infrared (755, Infrared (755, 800-810800-810, 940, 980, 1064), 940, 980, 1064)
Intense Pulsed Light (500-1200)Intense Pulsed Light (500-1200)
Absorption curve of the main chromophores
Wavelength (nm)
Ab
sorp
tion
coe
ffic
ien
tA
bso
rpti
on c
oeff
icie
nt
1000750500 1250
Selective photocoagulationSelective photocoagulation
PrinciplesPrinciples
1.1. Selective photocoagulation (not Selective photocoagulation (not
photothermolysis): longer pulses allow more photothermolysis): longer pulses allow more
thermal damage to vessel walls thermal damage to vessel walls
(methemoglobin?- Mordon S. et al. 2003)(methemoglobin?- Mordon S. et al. 2003)
2.2. Aggressive cooling allows skin protectionAggressive cooling allows skin protection
3.3. Both 1&2 protect darker skin typesBoth 1&2 protect darker skin types
Materials and methods:Materials and methods:
20 consecutive female patients with:20 consecutive female patients with:
– class I-III red telangiectasias,class I-III red telangiectasias,
– blue venulectasiasblue venulectasias
– reticular veins were treated with a combination of 532 nm (1000μ, 9-12 j/cm2) reticular veins were treated with a combination of 532 nm (1000μ, 9-12 j/cm2)
and 810nm (4mm, 80-90 j/cm2 ) lasers.and 810nm (4mm, 80-90 j/cm2 ) lasers.
Patients with significant venous circulatory impairment were excluded.Patients with significant venous circulatory impairment were excluded.
Both treatments were applied with contact skin cooling. Both treatments were applied with contact skin cooling.
The results were examined by digital macrophotographic imaging and The results were examined by digital macrophotographic imaging and
a patient evaluation scale.a patient evaluation scale.
Results:Results:
Significant clearance (at least 66%) was obtained in Significant clearance (at least 66%) was obtained in 1.8 sessions in 85 % of patients. 1.8 sessions in 85 % of patients.
The satisfaction was good in 95 % of patients.The satisfaction was good in 95 % of patients.
66
68
70
72
74
76
78
80
82
%
Colour
% of Vessel Clearance
Red
Blue
Purple
Teleangectasie degli arti Teleangectasie degli arti inferiori:inferiori:principi di laser-Tx principi di laser-Tx •Inquadramento flebologico
•Scleroterapia dei vasi iniettabili
•Prevenzione (Reflusso, abuso di UV, moto, calze)
•Visione (luce polarizzata)
•Raffreddamento cutaneo
F, 42 ys old.F, 42 ys old.Rt lower lateral thigh mattingRt lower lateral thigh matting
532 nm, 500532 nm, 500μ, ed 22.5 j/cmμ, ed 22.5 j/cm22, 2 , 2 treatments.treatments.
Landmarks Landmarks
1. MATTING
47 ys F. Matting lt calf47 ys F. Matting lt calf1 pass, 532 nm, 1000 micron, 11 j\cm2, 6 Hz1 pass, 532 nm, 1000 micron, 11 j\cm2, 6 Hz
Before AfterBefore After
1. MATTING – cont.
2.SCARRING2.SCARRING4343 ys, F. - rt thigh ys, F. - rt thigh
Post sclerotherapy
Before After
33 ys old.Left popliteal area. 810 nm, 4mm33 ys old.Left popliteal area. 810 nm, 4mm, ed 90 j/cm, ed 90 j/cm22,1pass,1pass
3.ALLERGY3.ALLERGY
Case description:Case description: Lt popliteal area Lt popliteal area (i.e. back of the knee) of a 56 ys old (i.e. back of the knee) of a 56 ys old woman with varices. (The rt leg has woman with varices. (The rt leg has also been treated later and you’ll get also been treated later and you’ll get the pictures in a few weeks). the pictures in a few weeks). Parameters:Parameters: 800 nm ed 45 j/cm 800 nm ed 45 j/cm22, 50 , 50 msec, 1 Hz, chilled tip, 1 session. msec, 1 Hz, chilled tip, 1 session.
Treatment:Treatment: slight pressure on the slight pressure on the skin with the handpiece. Treat until skin with the handpiece. Treat until the vein shrinks and disappears the vein shrinks and disappears within a few seconds. Stop before within a few seconds. Stop before you see the skin turning grayish: you see the skin turning grayish: that’s a burn. 10-20 days after that’s a burn. 10-20 days after treatment the veins are still present treatment the veins are still present and full of coagulated blood, that I and full of coagulated blood, that I remove by squeezing it through remove by squeezing it through small punctures in the skin and vein small punctures in the skin and vein wall that are absolutely painless. wall that are absolutely painless. This patient only used a mild cream This patient only used a mild cream after treatment: no bandages, after treatment: no bandages, compressive stockings nor activity compressive stockings nor activity limitations were adopted.limitations were adopted.*The preexisting little white scar is shown as a *The preexisting little white scar is shown as a landmarklandmark
21.11.2001
23.1..2002
Landmark*
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
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
Conclusioni:
Dopo 3 trattamenti
532 nm, scanner, 3 msec
Prima
Thank you for your attention
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