Morton R. Maser

Histology of port wine stains following argon laser treatment

Abstract The argon laser has now been firmly established as an effective treatment of certain port wine stain haemangiomas (Apfelberget al., 1977; Goldman and Dreffer, 1977) and we have studied the histological changes which occur following treatment.

Argon laser treatment of cutaneous vascular abnormalities: progress report.

One hundred six cutaneous vascular abnormalities were treated over a 3-year period by the argon laser. Absorption of light energy causes heat coagulation of the hemangioma with sparing of the overlying skin and secondary skin appendages. Patients with port wine hemangiomas, capillary/cavernous hemangiomas, and telangiectasia showed good response to argon laser treatment. Superficial varicosities of the lower extremity proved to be relatively insensitive to laser treatment. The argon laser shows promise as an effective clinical tool in the treatment of hemangiomas: however, further clinical and laboratory investigation will be necessary to establish the laser as the modality of choice in the treatment of such lesions.

Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques.

An analysis of the benefits of submuscular versus subcutaneous implantation was made on mastectomy patients. Ninety-one breast were reconstructed following mastectomy. In 30 breasts, the implants were placed subcutaneously; in 19, subpectorally, and in 42, beneath both the pectoralis and the serratus. The follow-up averaged 2 to 3 years, and recent cases included postoperative tonometry measurements to quantitate the degree of capsular contraction. In addition, 12 cadaver dissections were done to delineate muscle insertion and origins. Results indicate that (1) submuscular implants are clearly superior to subcutaneous ones; (2) subpectoral implantation requires complete detachment of the muscular origin from the ribs; (3) subserratus implantation provides extra muscular coverage, but dissection is more difficult owing to its firm rib attachment; and (4) the subserratus technique provided the lowest incidence of capsular contracture, although the breast was slightly flatter initially, but improved with time.

Benefits of the CO2 laser in oral hemangioma excision.

Twenty-one patients with small localized oral cavity hemangiomas of the lips, tongue, and buccal mucosa are reported in this series. Although the lesions were not massive or high-flow/high-pressure vascular tumors, the simultaneous cutting and coagulation capabilities of the CO2 laser were demonstrated, rendering such excisional surgery more precisely and easily accomplished with a great deal less bleeding and a marked reduction in postoperative pain and edema. Many of the patients in this series were done as outpatients under local anesthesia. Results were acceptable and complications were minimal. Thus this laser is recommended both for the patient care and comfort aspects and the ability to render oral cavity hemangioma excisional surgery much more safely and easily done with a significant decrease in hospital utilization and overall medical expenses.

Argon laser treatment of decorative tattoos

The argon laser shows promise as an effective clinical method for the treatment of tattoos. Although clinical follow-up has been limited to 3 years and less in a series of 30 patients, the preliminary results are sufficiently optimistic to recommend further clinical use of the argon laser for such treatment.

Comparison of Argon and Carbon Dioxide Laser Treatment of Decorative Tattoos: A Preliminary Report

Seven patients with either homemade or professional decorative tattoos have been treated with both the argon and CO2 lasers and studied clinically as well as histologically. The argon laser is absorbed by dermal pigment and vaporizes this pigment out of the skin. The CO2 laser vaporizes tissue layer by layer and must be accompanied by mechanical debridement. Results and complications of treatment with the two lasers were markedly similar, as were histological studies.

Carbon dioxide laserbrasion for treatment of adenoma sebaceum in tuberous sclerosis.

Adenoma sebaceum is a disfiguring facial deformity that constitutes part of the multiple system involvement in tuberous sclerosis. Three affected patients have been treated with carbon dioxide “laserbrasion,” which has resulted in a long-lasting improvement without scarring or recurrence. Tuberous sclerosis is described, and the CO2 technique is discussed.

Review of usage of argon and carbon dioxide lasers for pediatric hemangiomas

Pathophysiological effects of the argon and carbon dioxide lasers are discussed in detail in reference to pediatric hemangioma problems. Capillary/cavernous hemangioma excision by lasers is illustrated by case examples. Benefits as well as indications for laser usage in the pediatric age group are reviewed. Relatively bloodless excision of hemangiomas by the laser renders this modality particularly valuable for pediatric patients.

Benefits of contact and noncontact YAG laser for periorbital hemangiomas.

Twenty patients with capillary/cavernous hemangiomas of the periorbital area (eyelid, eyebrow, nose extending to canthus) have been treated with a variety of techniques. Six patients were treated by yttrium-aluminum-garnet (YAG) laser photocoagulation and direct injection of steroids. Rapid shrinkage of the hemangiomas occurred in all patients, and 2 infants whose eye was totally occluded by the hemangioma had their eyes rapidly opened. YAG laser excision with or without previous photocoagulation plus injection and with arteriogram plus superselective embolization was performed in the other 14 patients. Results were satisfactory in all patients.

Trichoepithelioma: successful treatment with the argon laser.

The cosmetic concern associated with multiple trichoepitheliomas is obvious. Previous modes of therapy have proven to be only temporary. However, multiple trichoepitheliomas appear to respond to the thermocoagulation and epidermal atrophic effects of the argon laser without recurrence over an extended follow-up period. Although these lesions are not as highly vascular as port-wine hemangiomas, their dramatic response to the argon laser is similar. This report documents a case of multiple trichoepitheliomas treated successfully with the argon laser from the face and scalp of a 29-year-old white woman. The benefits of the argon laser in treatment of multiple trichoepitheliomas include eradication of the lesions without apparent recurrence, restriction of spread of solitary trichoepithelioma into adjacent tumors, and prevention of obstruction of the periorbital region and auditory canal. The treatment may be accomplished as a simple outpatient procedure under local anesthesia with minimal pain or disability.