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Laser Treatments in phlebology Daniel Cassuto Milano, Prof. a C. Chirurgia Plastica Università di Catania.

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Presentation on theme: "Laser Treatments in phlebology Daniel Cassuto Milano, Prof. a C. Chirurgia Plastica Università di Catania."— Presentation transcript:

1 Laser Treatments in phlebology Daniel Cassuto Milano, Prof. a C. Chirurgia Plastica Università di Catania

2 Possible complications treatable by laser Tx Surgical scars Post skin necrosis Matting Post inflammatory hyperpigmentation Allergic reactions to sclerotherapy

3 Ingrandimento sotto illuminazione polarizzata Strutture superficiali Strutture epidermiche

4 Polarized light viewer: Light source Polaroid filters Magnifying lenses Head rest

5 Normal view Polarized view

6 Post 1

7 After 5 sessions of LBO (scanned and 1000µ) at various fluences. 18 months follow up

8 Pre post2 post3 post5

9 Matting of the leg through normal magnifying illumination Matting of the leg through polarized light magnification

10 Wavelengths used for leg veins Visible (532, 578, 585, 595, 600) Infrared (755, , 940, 980, 1064) Intense Pulsed Light ( )

11 Absorption curve of the main chromophores Wavelength (nm) Absorption coefficient

12 Selective photocoagulation

13 Principles 1. Selective photocoagulation (not photothermolysis): longer pulses allow more thermal damage to vessel walls (methemoglobin?- Mordon S. et al. 2003) 2. Aggressive cooling allows skin protection 3. Both 1&2 protect darker skin types

14 Materials and methods: 20 consecutive female patients with: –class I-III red telangiectasias, –blue venulectasias –reticular veins were treated with a combination of 532 nm (1000μ, 9-12 j/cm2) and 810nm (4mm, j/cm2 ) lasers. Patients with significant venous circulatory impairment were excluded. Both treatments were applied with contact skin cooling. The results were examined by digital macrophotographic imaging and a patient evaluation scale.

15 Results: Significant clearance (at least 66%) was obtained in 1.8 sessions in 85 % of patients. The satisfaction was good in 95 % of patients.

16 Teleangectasie degli arti inferiori: principi di laser-Tx Inquadramento flebologico Scleroterapia dei vasi iniettabili Prevenzione (Reflusso, abuso di UV, moto, calze) Visione (luce polarizzata) Raffreddamento cutaneo

17 F, 42 ys old. Rt lower lateral thigh matting 532 nm, 500μ, ed 22.5 j/cm 2, 2 treatments. Landmarks 1. MATTING

18 47 ys F. Matting lt calf 1 pass, 532 nm, 1000 micron, 11 j\cm2, 6 Hz Before After 1. MATTING – cont.

19 2.SCARRING 43 ys, F. - rt thigh Post sclerotherapy BeforeAfter

20 33 ys old.Left popliteal area. 810 nm, 4mm, ed 90 j/cm 2,1pass 3.ALLERGY

21 Case description: Lt popliteal area (i.e. back of the knee) of a 56 ys old woman with varices. (The rt leg has also been treated later and youll get the pictures in a few weeks). Parameters: 800 nm ed 45 j/cm 2, 50 msec, 1 Hz, chilled tip, 1 session. Treatment: slight pressure on the skin with the handpiece. Treat until the vein shrinks and disappears within a few seconds. Stop before you see the skin turning grayish: thats a burn days after treatment the veins are still present and full of coagulated blood, that I remove by squeezing it through small punctures in the skin and vein wall that are absolutely painless. This patient only used a mild cream after treatment: no bandages, compressive stockings nor activity limitations were adopted. *The preexisting little white scar is shown as a landmark Landmark*

22 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

23 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

24 Thank you for your attention

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