Quantitative data regarding photothermal and damage processes during pulsed laser irradiation of blood are necessary to achieve a better understanding of laser treatment of cutaneous vascular lesions and improve numerical models. In this study, multiple experimental techniques were employed to quantify the effects of single-pulse KTP laser (X = 532 nm, t, = 10 ms) irradiation of whole blood in vitro: high-speed temperature measurement with a thermal camera in line-scan mode (8 kHz); optical coherence tomography (for determination of coagulum morphology); and transmission measurement with a co-aligned laser beam (X = 635 nm) Threshold radiant exposures for coagulation (4.4-5.0 J/cm2) and ablation (-12 J/cm2) were identified. Thermal camera measurements indicated threshold coagulation temperatures of 90-100 °C, and peak temperatures of up to 145 °C for sub-ablation radiant exposures. Significant changes in coagulum thickness and consistency, and a corresponding decrease in transmission, were observed with increasing radiant exposure. The Arrhenius equation was shown to produce accurate predictions of coagulation onset (using appropriate rate process coefficients). The significance of dynamic effects such as evaporative loss and dynamic changes in optical properties was indicated. Implications for numerical modeling are discussed. Most importantly, the threshold temperatures typically quoted in the literature for pulsed laser coagulation (60-70 °C) and ablation (100 °C) of blood do not match the results of this study.
The use of indocyanine green-doped albumin protein solders has been shown to vastly improve the anastomotic strength that can be achieved by laser tissue repair techniques, while at the same time minimizing collateral thermal tissue damage. However, the safety of the degradation products of the chromophore following laser irradiation is uncertain. Therefore, we studied the feasibility of using alternative chromophores in terms of temperature rise at the solder/tissue interface, the extent of thermal damage in the surrounding tissue, and the tensile strength of repairs. Biodegradable polymer scaffolds of controlled porosity were fabricated with poly(L-lactic-co-glycolic acid), using a solvent-casting and particulate-leaching technique. The porous scaffold acted as a carrier to the traditional protein solder composition of serum albumin and an absorbing chromophore mixed in deionized water. Two commonly used chromophores, indocyanine green and methylene blue were investigated, as well as blue and green food colorings.Temperature rise at the solder surface and at the interface between the solder and tissue were monitored by an IR temperature monitoring system and a type-K thermocouple, respectively, and the extent of thermal damage in the underlying tissue was determined using light microscopy. As expected, temperature rise at the solder/tissue interface, and consequently the degree of collateral thermal tissue damage, was directly related to the penetration depth of the laser light in the protein solder. Optimal tensile strength of repairs was achieved by selecting a chromophore concentration that resulted in a temperature of 66 ± 3 °C at the solder/tissue interface.
Laser-assisted repair of nerves is often unsatisfactory and has a high failure rate. Two disadvantages of laser assisted procedures are low initial strength of the resulting anastomosis and thermal damage of tissue by laser heating. Temporary or permanent stay sutures are used and fluid solders have been proposed to increase the strength of the repair. These techniques, however, have their own disadvantages including foreign body reaction and difficulty of application.To address these problems solid protein solder strips have been developed for use in conjunction with a diode laser for nerve anastomosis. The protein helps to supplement the bond, especially in the acute healing phase up to five days post-operative. Indocyanine green dye is added to the protein solder to absorb a laser wavelength ('8OO nm) that is poorly absorbed by water and other bodily tissues. This reduces the collateral thermal damage typically associated with other laser techniques.An investigation of the feasibility of the laser-solder repair technique in terms of required laser irradiance, tensile strength of the repair, and solder and tissue temperature is reported here. The tensile strength of repaired nerves rose steadily with laser irradiance reaching a maximum of 105 10 N.cm2 at 12.7 W.cm2 . When higher laser irradiances were used the tensile strength of the resulting bonds dropped. Histopathological analysis of the lasersoldered nerves, conducted immediately after surgery, showed the solder to have adhered well to the perineurial membrane, with minimal damage to the inner axons of the nerve. The maximum temperature reached at the solder surface and at the solder/nerve interface, measured using a non-contact fibre optic radiometer and thermocouple respectively, also rose steadily with laser irradiance. At 12.7 W.cm2 , the temperatures reached at the surface and at the interface were 85 4 and 68 4 °C respectively.This study demonstrates the feasibility of the laser-solder repair technique for nerve anastomosis resulting in improved tensile strength. The welding temperature required to achieve optimal tensile strength has been identified.
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