Middermal wound healing. A comparison between dermatomal excision and pulsed carbon dioxide laser ablation

Green, H. A.

doi:10.1001/archderm.128.5.639

Cited by 34 publications

(28 citation statements)

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“…The CO 2 and excimer lasers offer the advantage of a smoother and more regular wound surface compared to the erbium:YAG laser. The CO 2 laser inflicted the largest thermal damage with a coagulation depth of 70–100 µm which compares well to the modern ultrapulsed CO 2 laser [46,47,48]. However, this may not necessarily limit the success of surgery as reported by Beckman [40], who discussed wound healing after thermal injury after CO 2 laser ablation.…”

Section: Discussionmentioning

confidence: 77%

CO<sub>2</sub>, Excimer and Erbium:YAG Laser in Deep Sclerectomy

et al. 2008

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Purpose: Deep sclerectomy is a non-penetrating filtering procedure that is not generally accepted, as tissue dissection is difficult and varying success rates have been reported. The purpose of the present study was to compare the use of CO₂, excimer and erbium:YAG lasers in dissection of the deep corneoscleral lamella. Methods: In enucleated porcine eyes a superficial lamellar scleral flap of 5 × 5 mm was surgically dissected. The deep lamella was removed using a pulsed erbium:YAG, a CO₂ or an excimer laser (10 eyes/group). All eyes were analysed histologically and 3 in each group by scanning electron microscopy (SEM). Results: It is feasible to ablate the deep corneoscleral lamella with the CO₂, excimer and erbium:YAG lasers without perforating the anterior chamber. The following histology and SEM showed a smoother surface after dissection with the CO₂ and excimer lasers compared to the erbium:YAG laser. There was no thermal damage after excimer laser treatment, compared to a damage zone of 10–30 µm using the erbium laser and one of 70–100 µm with the CO₂ laser. Conclusions: Excimer,erbium:YAG and CO₂ lasers allow the microsurgical dissection of the deep lamella. The excimer and CO₂ lasers achieve a more regular and smoother tissue surface. The excimer laser has the advantage to dissect without thermal tissue damage.

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Section: Discussionmentioning

confidence: 77%

CO<sub>2</sub>, Excimer and Erbium:YAG Laser in Deep Sclerectomy

et al. 2008

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“…Using this model and our mass loss observations, the heat of ablation for fat was 2.4 kJ/cm 3 , and the ablation threshold radiant exposure was 1.05 J/cm 2 . These values for the ablation threshold (F th ) and heat of ablation (H a ) do not agree with the following values derived from energy balance, where the ablation threshold for fresh fat is given by:…”

Section: Discussionmentioning

confidence: 89%

“…It can remove tissue with better hemostasis than mechanical devices and can debride burn wounds [1][2][3]. Pulsed CO 2 laser ablation of dermis has been studied extensively and provides hemostatic ablation with residual thermal damage limited to ∼ 80-200 m [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Effects of heterogeneous absorption of laser radiation in biotissue ablation: Characterization of ablation of fat with a pulsed CO2 laser

Ross¹,

Domankevitz

Anderson

1997

Lasers Surg. Med.

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“…The use of continuous-wave CO2 lasers as cutting tools to debride burn eschar was first studied in the early 1970s as a means of reducing blood loss.18-21 Reduced bleeding secondary to extensive coagulation at the edge of laser-ablated wounds was demonstrated,19-27 but this same tissue damage caused delayed wound healing and prevented successful skin grafting.2834 A new approach to this problem is based on the fact that a brief exposure to a high-energy CO2 laser will result in tissue vaporization with minimal residual thermal damage if the laser exposure time (pulse duration) is less than the heat conduction time (thermal relaxation time) of the tissue. [35][36][37][38][39][40] The goal of this study was to compare high-power continuous-wave CO2 laser ablation with surgical excision for the removal of full-thickness burns in a porcine burn model. Immediate autografting was performed and graft take was evaluated after tangential laser and surgical excision.…”

mentioning

confidence: 99%

Carbon Dioxide Laser Ablation With Immediate Autografting in a Full-Thickness Porcine Burn Model

Glatter¹,

Goldberg²,

Schomacker³

et al. 1998

Annals of Surgery

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ObjectiveTo compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high-power continuous-wave C02 laser to sharply d6-brided wounds in a porcine model. Summary Background DataContinuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. MethodsFull-thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 1 50-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 ,um of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. ResultsThe laser-treated sftes were nearly bloodless. The mean residual thermal damage was 0.18 ± 0.05 mm. The mean graft take was 96 ± 1 1% in manual sftes and 93 ± 8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graftwound bed interface was greater in laser-d6brded sites. By postoperative day 180, the manual and laser sites were histologicalty identical. Vancouver scar assessment revealed no differences in scarning at postoperative day 180. ConclusionsLong-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laserablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long-term outcome.Although early excision and grafting of deep dermal and full-thickness burns has improved patient survival rates,'

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Middermal wound healing. A comparison between dermatomal excision and pulsed carbon dioxide laser ablation

Cited by 34 publications

References 0 publications

CO<sub>2</sub>, Excimer and Erbium:YAG Laser in Deep Sclerectomy

CO<sub>2</sub>, Excimer and Erbium:YAG Laser in Deep Sclerectomy

Effects of heterogeneous absorption of laser radiation in biotissue ablation: Characterization of ablation of fat with a pulsed CO2 laser

Carbon Dioxide Laser Ablation With Immediate Autografting in a Full-Thickness Porcine Burn Model

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