Abstract
During laser therapy of port wine stain (PWS) birthmarks, regions of persistent perfusion may exist. We hypothesize that such regions, which are not readily visible, exist even during laser surgery performed by highly experienced clinicians. The objective of this study was to use objective feedback to assess the acute vascular response to laser therapy. We have developed a clinic-friendly laser speckle imaging (LSI) instrument to provide the clinician with real-time images of blood flow during laser therapy. We acquired images from patients undergoing laser therapy of PWS birthmarks at Scripps Clinic and Beckman Laser Institute and Medical Clinic. We extracted blood flow maps from the acquired imaging data. Collectively, we have observed two regimes of patient response to therapy: 1) an immediate increase in perfusion within minutes after laser therapy; and 2) an overall decrease in blood perfusion approximately one hour after laser therapy, with distinct regions of persistent perfusion apparent in the majority of post-treatment blood-flow images. A comparison of blood flow in PWS and adjacent normal skin demonstrated that PWS blood flow can be greater than or sometimes equivalent to that of normal skin. Regions of persistent perfusion frequently exist immediately after laser therapy of PWS birthmarks. Existence of these regions may be correlated to the need for multiple treatment sessions to improve substantially PWS skin appearance. With the use of intraoperative LSI, immediate retreatment of these regions may improve the outcome of each session.
Highlights
Port wine stain (PWS) birthmarks are vascular malformations consisting of ectatic blood vessels in the papillary and upper reticular dermis [1]
Due to the overall poor success rate of laser therapy to achieve complete port wine stain (PWS) removal, a reasonable conclusion is that purpura formation itself is insufficient as a prognostic indicator
Purpura Formation Is Insufficient as a Prognostic Indicator of Photocoagulation To demonstrate this point, we present a representative example in which regions of persistent perfusion are visible in the region of visible purpura, immediately after laser treatment (Fig. 2)
Summary
Port wine stain (PWS) birthmarks are vascular malformations consisting of ectatic blood vessels in the papillary and upper reticular dermis [1]. Laser-induced rupture of blood vessels can lead to increased hemoglobin content diffusing into the perivascular space, without concurrent vessel photocoagulation [5] Such an event would manifest itself as purpura formation. During laser therapy of port wine stain (PWS) birthmarks, regions of perfusion may persist. We hypothesize that such regions are not readily observable even when laser surgery is performed by highly experienced clinicians. Results—Collectively, two types of patient responses were observed in response to laser exposure: (1) an immediate increase in perfusion within minutes after laser therapy; and (2) an overall decrease in blood perfusion ~1 hour after laser therapy, with distinct regions of persistent perfusion apparent in the majority of post-treatment blood-flow images. We hypothesize that immediate retreatment of these regions identified with LSI, will result in enhanced removal of the PWS vasculature
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