Depth of vaporization and the effect of pulse stacking with a high-energy, pulsed carbon dioxide laser

被引:40
作者
Fitzpatrick, RE
Smith, SR
Sriprachya-anunt, S
机构
[1] Dermatol Associates San Diego Cty Inc, Encinitas, CA 92024 USA
[2] Univ Calif San Diego, Dept Med, Div Dermatol, San Diego, CA 92103 USA
[3] USN, Med Ctr, Dept Dermatol, San Diego, CA 92152 USA
[4] Pornkasem Skin & Laser Ctr, Bangkok, Thailand
关键词
D O I
10.1016/S0190-9622(99)70447-0
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background: Laser resurfacing of photodamaged skin has become popular, but questions regarding its safety with regard to the risks of scarring have arisen. Objective: This study was designed to investigate the depth of vaporization and residual thermal necrosis of single-pulse vaporization and multiple passes versus pulse-stacking and multiple passes. The potential significance of operator technique and laser parameters is considered. Methods: Skin samples from surgical excisions were treated by means of a Coherent Ultrapulse carbon dioxide laser at 250 mJ per pulse and 500 mi per pulse with a 3 mm collimated beam and a repetition rate of 10 Hz. A total of 70 treatment areas were performed. Blinded analysis of the histologic effects of single-pulse, double-pulse, and triple-pulse vaporization after 1 through 10 passes was undertaken. Results: A plateau of vaporization was observed after 3 passes at both 250 and 500 mJ whether single-, double-, or triple-pulse vaporization was used. This plateau occurs at approximately 100 to 250 mu m from the skin surface. Thermal necrosis is well controlled only with single-pulse vaporization. There is a direct linear increase in the depth of thermal necrosis both with the number of pulses stacked and the number of passes. Conclusion: Pulsed carbon dioxide laser resurfacing is a safe and self-limited procedure if a pulse width of less than 1 msec is used with single-pulse vaporization and fluences of 3.5 J/cm(2) and 7.0 J/cm(2). There appears to be little justification for performing more than 3 or 4 passes. Pulse stacking may significantly increase residual thermal necrosis, thereby increasing the risk of scarring. Operator technique may be significant in avoidance of this occurrence.
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收藏
页码:615 / 622
页数:8
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