Use of the Carbon Dioxide (infrared) Laser in cutaneous surgery

Use of the Carbon Dioxide (infrared) Laser in cutaneous surgery

The effective and safe use of the CO2 laser has been facilitated by advances in the UltraPulse computerized CO2 laser system. The clinical use has not only been benefited by this laser, but a better understanding of the laser – tissue interactions, refinements in techniques, and expansion of the list of clinical indications. The use of the UltraPulse CO2 laser simplifies many procedures, is effective for treating an expanded number of cutaneous lesions and is the preferred treatment for an increasing number of others.

Selected use of the Ultrapulse CO2 Laser

I.    Nevoid Lesions

1.    Large Seborrheic Keratoses
2.    Aggressive Nevi
3.    Compound and Dermal Nevi (face and elsewhere)
4.    Dermatosis Papulosa Nigra (DPN’s)

II.    Pre-Malignant & Malignant Cutaneous Lesions

1.    Hypertrophic Actinic Keratoses
2.    Cutaneous Horns
3.    Keratoacanthomas
4.    Bowen’s Disease
1.    Basal Cell Carcinomass  [Special cases]
5.    Squ(Special cases)
6.    Squamous Cell Carcinomas (Special cases)

III.    Vascular Lesions

1.    Pyogenic Granulomas
2.    Angiomatous proliferation in hemangiomas
3.    Angiofibromas (nose)
4.    Elevated Cherry Angiomas

IV.    Other Lesions

1.    Fibromas – nose
2.    Nevus Sebaceous of Jadassohn
3.    Epidermal Nevi – Nevus Verrucosus
4.    Tuberous Sclerosis Lesions of the Face and Koenen’s Fibromas (nail folds)
5.    Chondrodermatitis nodularis Chronicus helicis – ears
6.    Pilar Cysts
7.    Oral Lesions:
a)    Leukoplasia
b)    Fibromas
c)    Mucous Cysts
8.    Syringomas (upper and lower eyelid)
9.    Xanthelasma (eyelids)
10.    Trichoepitheliomas
11.    Ears – keloids, focused excision mode and defocused mode
12.    Focused excision mode technique
a)    Scalp Pilar Cysts
b)    Sebaceous cysts
c)    Epidermal Inclusion Cysts
d)    Lipomas

The UltraPulse CO2 laser system is often used in the defocused mode as a vaporization tool, but can be used as a surgical scalpel in the focused mode in excising lesions such as pilar cysts of the scalp, lipomas, sebaceous cysts, basal cell carcinomas, squamous cell carcinomas and numerous other selected conditions.   This focused laser technique has made the upper eyelid transcutaneous blepharoplasty and the lower eyelid transconjunctival blepharoplasty a very tidy procedure; replacing the cold scalpel method.  The advantage of having a bloodless field makes it possible to perform selected cutaneous surgery in patients on anticoagulants and patients with bleeding disorders.  The laser sterilizes as it incises or vaporizes and does not interfere with pacemakers or electronic monitoring devices.

There are many other advantages of the CO2 laser as a surgical tool including limited destruction of surrounding tissue, rapid surgery, relative hemostasis during the procedure and a minimum post operative pain because of the sealing of nerve endings as opposed to just cutting them.

The UltraPulse CO2 laser results are often better than alternatives in the following conditions:

1.    In patients:
a)    with bleeding disorders
b)    in whom Epinephrine or local anaesthetics are contraindicated
c)    requiring pacemakers or monitoring devices
d)    for whom blood loss may be life threatening
2.    Special Sites
a)    infected surgical sites
b)    vascular tissues
3.    Recalcitrant aggressive warts
4.    Facial Compound & Dermal Nevi
5.    Nose – Fibromas
6.    Large Seborrheic Keratoses
7.    Upper eyelid transcutaneous Blepharoplasties and lower eyelid transconjunctival Blepharoplasties.

The CO2 laser systems are now becoming the treatment of choice in treating:

1.    Rhinophyma
2.    Keloid scars – ears
3.    Dermatosis Papulosa Nigra Lesions (DPN’s)
4.    Repair of split pierced ear lobes
5.    Pyogenic Granulomas
6.    Lower Lip Vermilionectomy procedure for Actinic Cheilitis and Leukoplakia