Carbon Dioxide Laser Surgery in HS

In the early 1990s we were looking for a treatment for the most common type of HS, with a high likelihood of cure, a low recurrence rate, and one that avoided hospital admission and general anesthesia, with minimal inconvenience and time off work for the patient. One of us (J.L.) developed a modified "minimally invasive" carbon dioxide laser procedure followed by healing by secondary intention [38, 41]. There now follows a detailed description of this method.

The method involves using the simple, fast, hand-movement-controlled "paintbrush" technique and a Sharplan carbon dioxide laser (CO2) 1030 ® (Laser Industries, Tel Aviv, Israel) operating at 30 W [38]. Since 1993 the method has been modified, taking advantage of the introduction of carbon dioxide laser scanners (rapid beam optomechanichal microprocessed scanner systems). From 1993 to 1994: SwiftLase® (the optomechanical flash scanner, SwiftLase, model 755, Laser Industries); from 1995 to the present day: SilkTouch® (the optomechanical flash scanner, Silktouch, model 765, Laser In dustries). A focusing handpiece from a Sharplan carbon dioxide laser 1030® is attached to the miniature optomechanical flash scanner delivery system, which generates a focal spot that rapidly and homogeneously carries out a spiral scan and covers a circular area of tissue at the focal plane.

The symptomatic lesions, according to the patient's opinion regarding discharge, inflammation, infiltration or suspected abscesses, are selected for treatment. Areas that had been "silent" for more than 2 years but with signs of earlier activity, i.e., scars with postinflammatory hyperpigmentation, sometimes with dry comedones but with no actual inflammatory activity detected, are judged as "burned out" and left untreated. The diseased skin is macroscopically scrutinized for scarring, tissue distortion and discoloration, dry or suppurating sinuses, mac-rocomedones and other superficial signs. The examination is completed with palpation of the defects for bulky indurations and small, firm subcutaneous nodules or fluctuating purulent tissue. The selected area is ablated with the laser beam by passing it over the tissues with as much power as is controllable in the surgical situation. After wetting the surface with a 0.9% sodium chloride solution to remove devitalized tissue and drying it with a swab, the treated area can be evaluated and repeated ablations are possible in the same manner. The depth of each level of vaporization is controlled by the selection of power, focal length, scanner-controlled spot size and the velocity of the movements of the handheld scanner. We use 20-30 W, 3- to 6-mm spot size, and 12.5 or 18 cm focal length setting. The resulting depth of the vaporization procedure is determined after inspection for signs of healthy and diseased cutaneous tissue. The vaporization procedure is repeated downward and outward until fresh yellow fat tissue is exposed in the deep and relatively thin and anatomically normal skin margins laterally, with no remaining dense or discolored tissue. Usually the vaporization reaches the deep subcutaneous fat or the fascia. In the axillary region, major vessels and the nerve plexus have to be protected but this depth is seldom reached in patients with Hurley Stage II [29] HS as treated in this manner. The smaller blood vessels are readily and conve

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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