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Laser Dictionary 2.

Ecto Derma Polyclinic - Dental - Medical - Laser  Educational and Research Center

1085. Budapest, József krt.37.  Hungary  Tel.: +36 1 3178175 ; +36 1 2350024
Fax.: +36 1 2350025  Email:  titkarsag@ectoderma.hu recepcios@ectoderma.hu

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What is it mean “no touch operation”?

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During coagulation and vaporisation, the tissues were touched only by the laser beam. During excision, only the continuous traction of the pathologic area was performed using conventional instruments. Healthy tissues were not tugged or traumatized:no pathogens or their toxins or tumour cells were transmitted by this "no-touch" technique onto the healthy regions. This tissue-saving technique results also from the fact that the coagulation and vaporisation performed by the laser beam allows greater  selectivity than any other existing method, removing only the pathologic tissues while sparing the healthy structures. In the case of cutting the CO2 laser knife results in a thermodamaged zone of 300 microns in thickness: thus the thermal damage of the healthy area is minimal.
The aseptic applicability results partly  from the fact that the laser beam immediately destroys the pathogens on the incised surface, after lasing, the wound surfaces are  covered by a protective layer of coagulated proteins, which provides favourable conditions for the epithelialization of the occasionally large areas concerned.

What is it mean minimal postoperative pain?

Regarding the degree of postoperative pain, the evaluation was based on patients,  reports. Of the 4o32 patients operated on,  1o86 (26.9%) required analgesics on the day of the operation. One day later, only 291  (7.2%) patients required analgesics. On the operative day, the patients did not observe swallowing or nourishing disturbance: they were able to take oral nourishment by themselves .

What is it mean good the speed and quality of wound healing?

As to the speed and quality of wound healing, the epithelialization terminated by the third week in case of coagulation, and by the fourth week when vaporisation and excision were performed. Lesions of smaller surfaces recovered sooner. When evaluating the patients after a follow-up of 2-7 years, we found that out of  4o32 patients,    3838  were symptom free (95.1%) .
Recurrence developed in 184 cases and 1o patient died due to other (cardiovascular) disease. 
In the relapsing cases, a second lasing was performed that resulted in a symptom-free condition (in 151  of the 184 cases).

What is the role of surgical lasers in dermatology, cosmetology?

In removing different lesions of the skin of the face with lasers, the precise ablation rate, the haemostatic effect of the laser beam markedly manifests itself.
The removal of scars, different benign tumours and tumour like lesions, pigmented areas, haemophilic configurations, the resurfacing of the wrinkles and other methods often presents a difficult task for surgeons. The application of the Er YAG, CO2 , argon, Nd YAG, and Combo lasers has brought a new operative technical approach in the field of aesthetic surgery.

What is the Er YAG laser role in Dematology?

Removal of facial skin lesions by the Er YAG laser: It has excellent ablation effect, high repetition rates, thermal necrosis did not exceed 50 um, corresponding clinically to capillary bleeding after exposure of the dermis.
Pulsed Er YAG laser surgery allows an extremely precise etching of delicate superficial skin lesions and also should have a potential for skin resurfacing. The evaluation of results of different laser surgical methods show real advantages and disadvantages of these methods.

Advantages of Er YAG laser

Practical experience shows, that ablation requires more than 2J/cm2 density of energy. The effect on the skin over this threshold density results precise ablation of the irradiated upper layer. The thickness of the removed skin by one impulse depends on the energy and can rich also 100 micron. 
In ablation working mode the water in the tissues is warming till boiling point, then resulting an explosion like vaporisation. Due to big differential pressure the tissue removal is happening in the form of micro-explosions. The doctor can hear crackling sound (which frequency is in line with energy density) and in this way follows the removal of the tissues. 
In ablation mode the thickness of the coagulation zone is 10 micron at the edge of the crater.  
The required energy density in coagulation mode is between 0.5-1 J/cm2. No crackling sound can be hear, since the tissue is not removed, it stays its original place in the form burned, dehydrated, wipeable particulars. In this mode as the result of the laser impulse light yellow tissue can be seen. 
The adjustable optimal energy density significantly depends on the characters of the tissue, mainly on its water content.

Disadvantages of Er YAG laser application
  • Significant initial financial investment
  • Mandatory safety rules
  • Investment in people (training for people involved)
  • wrinkles treatment

Indication of Er YAG laser in skin lesions

- Resurfacing
- Scar treatment (hypertrophic, keloid)
- Pigmented lesions (Lentigo simplex, senile,Cafee-au-lait, Naevi
Spili, Epidermic naevus, Becker naevus, Chloasma
- Angiofibroma
- Keratosis actinica,seborrhoica, solaris
- Verruca
- Tatooes
- Xantelasma
- Syringoma
- Adenoma sebaceum
- Osteoma cutis
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