Low-strength anastomoses and thermal damage of tissue are major concerns in laser tissue welding techniques where laser energy is used to induce thermal changes in the molecular structure of the tissues being joined, hence allowing them to bond together. Laser tissue soldering, on the other hand, is a bonding technique in which a protein solder is applied to the tissue surfaces to be joined, and laser energy is used to bond the solder to the tissue surfaces. The addition of protein solders to augment tissue repair procedures significantly reduces the problems of low strength and thermal damage associated with laser tissue welding techniques. Investigations were conducted to determine optimal solder and laser parameters for tissue repair in terms of tensile strength, temperature rise and damage and the microscopic nature of the bonds formed. An in vitro study was performed using an 808 nm diode laser in conjunction with indocyanine green (ICG)-doped albumin protein solders to repair bovine aorta specimens. Liquid and solid protein solders prepared from 25% and 60% bovine serum albumin (BSA), respectively, were compared. The efficacy of temperature feedback control in enhancing the soldering process was also investigated. Increasing the BSA concentration from 25% to 60% greatly increased the tensile strength of the repairs. A reduction in dye concentration from 2.5 mg ml(-1) to 0.25 mg ml(-1) was also found to result in an increase in tensile strength. Increasing the laser irradiance and thus surface temperature resulted in an increased severity of histological injury. Thermal denaturation of tissue collagen and necrosis of the intimal layer smooth muscle cells increased laterally and in depth with higher temperatures. The strongest repairs were produced with an irradiance of 6.4 W cm(-2) using a solid protein solder composed of 60% BSA and 0.25 mg ml(-1) ICG. Using this combination of laser and solder parameters, surface temperatures were observed to reach 85+/-5 degrees C with a maximum temperature difference through the 150 microm thick solder strips of about 15 degrees C. Histological examination of the repairs formed using these parameters showed negligible evidence of collateral thermal damage to the underlying tissue. Scanning electron microscopy suggested albumin intertwining within the tissue collagen matrix and subsequent fusion with the collagen as the mechanism for laser tissue soldering. The laser tissue soldering technique is shown to be an effective method for producing repairs with improved tensile strength and minimal collateral thermal damage over conventional laser tissue welding techniques.

Background and Objectives: Previous studies have shown that the application of chromophore-enhanced albumin protein solders to augment laser tissue repairs significantly improves repair strength, enhances edge co-optation, and reduces thermal tissue injury. These investigations are furthered with this in vitro study conducted to assess a new range of specially designed chromophore-enhanced solid protein solders manufactured and tested for application during laser-assisted tissue repair. Study Design/Materials and Methods: The experimental study was divided into three parts. In the first part of the study, the creation of a chromophore concentration gradient across the thickness of the solid protein solder was investigated as a means to improve control of the heat source gradient through the solder during laser irradiation. In the second part of the study, predenaturation of the solid protein solder was investigated as a means for enhancing the stability of the solder in physiological fluids before irradiation. Finally, in the third part of the study, the feasibility of using synthetic polymers as a scaffold for traditional albumin protein solder mixes was investigated as a means of improving the flexibility of the solder. Results: Uniform denaturation across the thickness of the solder was achieved by controlling the chromophore concentration gradient, thus ensuring stable solder-tissue fusion when the specimen was submerged in a hydrated environment. Predenaturation of the solid protein solder significantly reduced the solubility of the solder, and consequently, improved the handling characteristics of the solder. The solder-doped polymer membranes were flexible enough to be wrapped around tissue, whereas their solid nature avoided problems associated with "run-away" of the less viscous liquid solders currently used by researchers. In addition, the solder-doped polymer membranes could be easily tailored to a wide range of geometries suitable to many clinical applications. Conclusion: The novel solid protein solder designs presented here add a new dimension to tissue repair as their flexible, moldable, and absorption controllable nature, greatly improves the clinical applicability of laser-assisted tissue repair.

Important terminal care outcomes can be significantly improved by targeting key nursing home physicians with an adult educational program that includes audit and feedback, and quality improvement suggestions.

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An investigation of the effects of laser irradiation with a wavelength of 532 nm and pulse duration of 10 ms on whole blood was performed in vitro. Threshold radiant exposures for coagulation were quantified and transient radiometric temperatures were measured. The progression of effects with increasing radiant exposure--from evaporation to coagulation-induced light scattering to aggregated coagulum formation to ablation--is described. Results indicate that coagulation and ablation occur at temperatures significantly in excess of those assumed in previous theoretical studies. An Arrhenius rate process analysis based on hemoglobin data indicates good agreement with experimental results.

Reinforcement of liquid albumin solders in laser-assisted incision repair seems to have advantages in terms of acute breaking strength over conventional methods that do not reinforce the cohesive strength of the solder.

greatly improved by increasing the BSA concentration. Finally, the lower ICG dye concentration increased the penetration depth of the laser light in the protein solder leading to higher tensile strengths. The strongest repairs were formed by using 6.4 W/cm 2 irradiation for 50 seconds with a protein solder composed of 60% BSA and 0.25mg/ml ICG. In addition, the solid protein solder provided more stable adhesion to the tissue than did the liquid protein solder when the tissue was submerged in a hydrated environment. Conclusions: This study greatly enhances the current understanding of the various factors affecting the soldering process. It provides a strong basis for optimization of the laser light delivery parameters and the solder constituents to achieve strong and reliable laser tissue repairs. Lasers Surg. Med. 24:319-331, 1999.

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