Islam, teaching dermatologic surgery, and porcine parts.
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The ablation rate of guinea pig skin and bovine aorta, myocardium, and liver by a CO2 laser emitting 2-microseconds-long pulses was quantified. Ablation efficiency was found to be strongly dependent upon the ultimate tensile strength of the tissue; the ablation efficiency of liver is seven times that of skin. Gluteraldehyde cross linking of skin, which is known to greatly increase tissue stiffness but not significantly affect ultimate tensile strength, did not change the ablation rate. The water content of the tissues, which largely determines the optical and thermal properties, was measured and found to vary only slightly. The results demonstrate that tissue mechanical properties are important in the interpretation and modeling of pulsed laser ablation of tissue and that variations in these mechanical properties can lead to drastically different cutting rates for different tissues.
Cryogenic sprays are used for cooling human skin during laser dermatologic surgery. In this paper, six straight-tube nozzles are characterized by photographs of cryogenic spray shapes, as well as measurements of average droplet diameter, velocity, and temperature. A single-droplet evaporation model to predict average spray droplet diameter and temperature is tested using the experimental data presented here. The results show two distinct spray patterns--sprays for 1.4-mm-diameter nozzles (wide nozzles) show significantly larger average droplet diameters and higher temperatures as a function of distance from the nozzle compared with those for 0.5-0.8-mm-diameter nozzles (narrow nozzles). These results complement and support previously reported studies, indicating that wide nozzles induce more efficient heat extraction than the narrow nozzles.
BACKGROUND: The CO2 laser is a common surgical modality in dermatology. To clarify conflicting reports on the histological healing properties of CO2 laser on incisional or ablative wounds, we have applied it in a miniature hairless porcine skin model at power settings similar to those used in clinical practice. METHODS: Histological parameters of wound healing in skin incisions using the CO2 laser were compared with those using scalpel, hot scalpel, and electrosection, and in dermal ablation using CO2 laser, fraize, wire brush, and electrofulguration alone or with curettage. RESULTS: In incisional wounds, tissue damage was most extensive in CO2 laser wounds, with delayed dermal healing and reepithelialization. In ablative wounds, CO2 laser caused a similar degree of tissue damage as did the electrosurgical modalities, and more damage than did fraize or wire brush. Reepithelialization was complete in CO2 laser, fraize, and wire brush wounds before electrosurgical wounds. Final histology of both incisional and ablative wounds at 6 weeks was similar with all surgical modalities. CONCLUSION: The CO2 laser and electrosurgery both produce greater focal tissue damage in incisional and ablative applications than the other modalities. Delayed epithelialization of the wound occurs with both modalities in incisional wounds but only with electrosurgery in ablative wounds. At 6 weeks, the appearance of the scar in all incisional and ablative modalities is similar grossly and histologically. Confirmation of these findings requires standardization of power density of the CO2 laser in incision and ablation.
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Ordinary plastic buttons may be used as bolster devices to relieve tension across wounds. This article describes the method of placement of those "button bolsters" and suggests two methods of closing the wound once they are in place. This simple technique is easily mastered and gives additional wound closure security in the initial phase of wound healing.
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The suture tensor is a simple stainless steel device that pulls the ends of a running subcuticular suture in opposite directions, maintaining the desired closure. The benefits of the use of this device may include minimization of train-track and excisional scarification (via the enhanced maintenance of "tenting"), time savings, and flexibility and durability for the sporting or physically active patient.
The authors describe a technique of intraoperative nasal ala stabilization to aid excision of skin lesions on the nasal ala and the surrounding skin. The fixation is achieved by inserting a Foley catheter into the nasal antrum and inflating the balloon. The inflated balloon produces pressure against the surrounding walls, allows convenient excision of skin lesions with good hemostasis, and is comfortable for the patient.
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