Laser treatment of port-wine stains (original) (raw)
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Practical Considerations in the Treatment of Capillary Vascular Malformations, or Port Wine Stains
Facial Plastic Surgery, 2004
Port wine stains (PWSs) represent the most common type of vascular malformation. With the advent of pulsed-dye laser therapy, treatment of these lesions has become achievable with minimal prospect of adverse scarring. Although many scientific articles have heralded the favorable outcomes in patients who have undergone pulsed-dye laser treatments, few articles address the practical considerations (pre-, intra-, and postoperative) that must be followed to ensure success. This article presents the 10-year experience of the senior author (EFW) in the management of port wine malformations and the clinical insights that have been gleaned from that extensive experience. Introductory remarks are made as to the nature of PWSs, related syndromes, and the evolution of treatment; practical management guidelines are then discussed.
An overview of clinical and experimental treatment modalities for port wine stains
Journal of the American Academy of Dermatology, 2012
Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy. ( J Am Acad Dermatol 2012;67:289-304.)
Surgery for Port-Wine Stains: A Systematic Review
Journal of Personalized Medicine
Background: Port-wine stains (PWS) are congenital low-flow vascular malformations of the skin. PWS tend to become thicker and darker with time. Laser therapy is the gold standard and the first-line therapy for treating PWS. However, some resistant PWS, or PWS that have tissue hypertrophy, do not respond to this therapy. Our aim is to evaluate the role of surgery in the treatment of PWS birthmarks. Methods: A literature search was performed in PubMed, Scopus, Web of Science (WOS) and Google Scholar for all papers dealing with surgery for port-wine stains, from January 2010 to December 2020 using the search strings: (capillary vascular malformation OR port-wine stains OR Sturge Weber Syndrome OR sws OR pws) AND (surgical OR surgery). Results: Ten articles were identified and used for analysis. They were almost all case series with a short follow up period and lacked an objective–systematic score of evaluation. Conclusions: Delay in treatment of port wine stains may result in soft tiss...
Site-specific pharmaco-laser therapy: a novel treatment modality for refractory port wine stains
Journal of Clinical and Translational Research, 2019
Despite extensive efforts to optimize laser therapy, i.e., the current gold standard treatment, a majority of port wine stain (PWS) patients responds suboptimally to laser therapy. This paper describes the niceties of a novel PWS treatment modality termed site-specific pharmaco-laser therapy (SSPLT). In contrast to the classic approach of enhancing the extent of intravascular photocoagulation (the photothermal response), SSPLT focuses on optimization of post-irradiation thrombus formation (i.e., the hemodynamic response) by combining conventional laser therapy with the administration of thermosensitive drug delivery systems that encapsulate prothrombotic and antifibrinolytic drugs. The aim of SSPLT is to instill complete lumenal occlusion in target vessels, which has been linked to optimal PWS blanching. Relevance for patients: The current treatment options for PWS patients are limited in efficacy. Novel therapeutic modalities are needed to more effectively treat patients with recalcitrant PWSs. SSPLT is an experimental-stage treatment modality that could serve as an adjuvant to pulsed dye laser therapy for a selected group of patients whose PWS is ill-responsive to standard treatment. The expected clinical result of SSPLT is improved lesional blanching.
Lasers in Medical Science, 1995
Selective photothermolysis with pulsed lasers is presumably the most successful therapy for port-wine stain birthmarks (flammeus nevi). Selectivity is obtained by using an optical wavelength corresponding to high absorption in blood, together with small absorption in tissues. Further on, the pulse length is selected to be long enough to allow heat to diffuse into the vessel wall, but simultaneously short enough to prevent thermal damage to perivascular tissues. The optical wavelength and pulse length are therefore dependent on vessel diameter, vessel wall thickness and depth in dermis. The present work demonstrates that in the case of a 0.45 ms long pulse at 585 nm wavelength, vessels of 40~0 Fm require minimum optical fluence. Smaller vessels require higher fluence because the amount of heat needed to heat the wall becomes a substantial fraction of the absorbed optical energy. Larger vessels also require a higher dose because the attenuation of light in blood prevents the blood in the centre of the lumen from participating in the heating process. It is shown that the commonly used optical dose in the range of 6-7 J cm-2 is expected to inflict vessel rupture rather than thermolysis in superficially located vessels. The present analysis might serve to draw guidelines for a protocol where the optical energy, wavelength and pulse length are optimized with respect to vessel diameter and depth in dermis.
Therapeutic response during pulsed laser treatment of port-wine stains
Selective photothermolysis with pulsed lasers is presumably the most successful therapy for port-wine stain birthmarks (flammeus nevi). Selectivity is obtained by using an optical wavelength corresponding to high absorption in blood, together with small absorption in tissues. Further on, the pulse length is selected to be long enough to allow heat to diffuse into the vessel wall, but simultaneously short enough to prevent thermal damage to perivascular tissues. The optical wavelength and pulse length are therefore dependent on vessel diameter, vessel wall thickness and depth in dermis. The present work demonstrates that in the case of a 0.45 ms long pulse at 585 nm wavelength, vessels of 40~0 Fm require minimum optical fluence. Smaller vessels require higher fluence because the amount of heat needed to heat the wall becomes a substantial fraction of the absorbed optical energy. Larger vessels also require a higher dose because the attenuation of light in blood prevents the blood in the centre of the lumen from participating in the heating process. It is shown that the commonly used optical dose in the range of 6-7 J cm-2 is expected to inflict vessel rupture rather than thermolysis in superficially located vessels. The present analysis might serve to draw guidelines for a protocol where the optical energy, wavelength and pulse length are optimized with respect to vessel diameter and depth in dermis.
Description and Analysis of Treatments for Port-wine Stain Birthmarks
Archives of Facial Plastic Surgery, 2005
P ort-wine stain (PWS) birthmarks are congenital, low-flow vascular malformations of the skin. Lasers are the modality of choice for the treatment of PWS birthmarks, and for most patients the pulsed-dye laser in conjunction with epidermal cooling offers the greatest efficacy and safety. Other light devices, including the 532-nm frequency-doubled Nd:YAG laser, intense pulsed light, 1064-nm Nd:YAG laser, and combined 1064/532-nm system, may be useful during a treatment course for resistant PWS. Laser treatment results in blanching of most lesions, although complete resolution may not occur and some resistant PWS birthmarks respond minimally, if at all. Factors limiting laser treatment include variable vascular geometry, inadequate damage of some vessels, and lesional posttreatment recurrence as a result of neovascularization. Alternative or adjunct treatment options that address these limitations should be explored, including noninvasive real-time imaging to optimize the selection of treatment settings, photodynamic therapy, and perioperative use of antiangiogenic compounds.
Wavelengths for laser treatment of port wine stains and telangiectasia
Lasers in Surgery and Medicine, 1995
Background and Objective: This report presents analytical modelling of the influence of wavelength on the amount of volumetric rate of heat produced in dermal blood vessels by millisecond laser radiation. Study designlMaterials and Methods: A new anatomical model is proposed that represents port wine stains as well as telangiectatic lesions. It consists of a target blood vessel, representing the deepest dermal blood vessel that requires irreversible injury, and a layer of whole blood, representing all other dermal blood vessels above the target vessel. The laser light that interacts with the blood vessels is assumed to be diffuse. Selective photothermolysis is the basis for the analysis. We consider wavelengths between 577 nm and 600 nm, the argon laser wavelengths at 4881515 nm, and the frequency doubled NdYAG laser wavelength at 532 nm. Results: The rate of volumetric heat production of absorbed laser light in the target blood vessel is expressed analytically as a function of blood absorption, the concentration of additional dermal blood, and the depth of the target vessel. Conelmion: The model explains why 585 nm is a good compromise for treating port wine stains that vary widely in number of dermal blood vessels. It predicts that wavelengths between 577 nm and 582 nm are excellent for the treatment of port wine stains in young children, and it suggests a possible explanation as to why the argon laser is sometimes said to be capable of treating dark mature port wine stains. The copper vapour laser wavelenght at 578 nm, and the frequency doubled Nd:YAG laser wavelength at 532 nm, are predicted to be suitable for the treatment of port wine stains that contain, respectively, a small to moderate and a moderate number of dermal blood vessels. When laser beam spotsize becomes smaller, the best wavelength for producing maximal rate of heat in the target vessel is predicted to shift t0 577 nm. Q 1995 Wiley-Liss, Inc.