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