Skin graft take and healing following 193-nm excimer, continuous-wave carbon dioxide (CO2), pulsed CO2, or pulsed holmium

YAG laser ablation of the graft bed

H. A. Green, E. E. Burd, N. S. Nishioka, Carolyn Compton

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Ablative lasers have been used for cutaneous surgery for greater than two decades since they can remove skin and skin lesions bloodlessly and efficiently. Because full-thickness skin wounds created after thermal laser ablation may require skin grafting in order to heal, we have examined the effect of the residual laser-induced thermal damage in the wound bed on subsequent skin graft take and healing. In a pig model, four different pulsed and continuous-wave lasers with varying wavelengths and radiant energy exposures were used to create uniform fascial graft bed thermal damage of approximately 25, 160, 470, and 1100 μm. Meshed split-thickness skin graft take and healing on the thermally damaged fascial graft beds were examined on a gross and microscopic level on days 3 and 7, and then weekly up to 42 days. Results: Laser-induced thermal damage on the graft bed measuring greater than 160±60 μm in depth significantly decreased skin graft take. Other deleterious effects included delayed graft revascularization, increased inflammatory cell infiltrate at the graft-wound bed interface, and accelerated formation of hypertrophied fibrous tissue within the graft bed and underlying muscle. Conclusions: Ablative lasers developed for cutaneous surgery should create less than 160±60 μm of residual thermal damage to permit optimal skin graft take and healing. Pulsed carbon dioxide and 193-nm excimer lasers may be valuable instruments for the removal of full-thickness skin, skin lesions, and necrotic tissue, since they create wound beds with minimal thermal damage permitting graft take comparable to that achieved with standard surgical techniques.

Original languageEnglish (US)
Pages (from-to)979-988
Number of pages10
JournalArchives of Dermatology
Volume129
Issue number8
DOIs
StatePublished - 1993
Externally publishedYes

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Solid-State Lasers
Laser Therapy
Carbon Dioxide
Transplants
Skin
Hot Temperature
Lasers
Dermatologic Surgical Procedures
Wounds and Injuries
Excimer Lasers
Skin Transplantation
Swine
Muscles

ASJC Scopus subject areas

  • Dermatology

Cite this

Skin graft take and healing following 193-nm excimer, continuous-wave carbon dioxide (CO2), pulsed CO2, or pulsed holmium : YAG laser ablation of the graft bed. / Green, H. A.; Burd, E. E.; Nishioka, N. S.; Compton, Carolyn.

In: Archives of Dermatology, Vol. 129, No. 8, 1993, p. 979-988.

Research output: Contribution to journalArticle

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abstract = "Background: Ablative lasers have been used for cutaneous surgery for greater than two decades since they can remove skin and skin lesions bloodlessly and efficiently. Because full-thickness skin wounds created after thermal laser ablation may require skin grafting in order to heal, we have examined the effect of the residual laser-induced thermal damage in the wound bed on subsequent skin graft take and healing. In a pig model, four different pulsed and continuous-wave lasers with varying wavelengths and radiant energy exposures were used to create uniform fascial graft bed thermal damage of approximately 25, 160, 470, and 1100 μm. Meshed split-thickness skin graft take and healing on the thermally damaged fascial graft beds were examined on a gross and microscopic level on days 3 and 7, and then weekly up to 42 days. Results: Laser-induced thermal damage on the graft bed measuring greater than 160±60 μm in depth significantly decreased skin graft take. Other deleterious effects included delayed graft revascularization, increased inflammatory cell infiltrate at the graft-wound bed interface, and accelerated formation of hypertrophied fibrous tissue within the graft bed and underlying muscle. Conclusions: Ablative lasers developed for cutaneous surgery should create less than 160±60 μm of residual thermal damage to permit optimal skin graft take and healing. Pulsed carbon dioxide and 193-nm excimer lasers may be valuable instruments for the removal of full-thickness skin, skin lesions, and necrotic tissue, since they create wound beds with minimal thermal damage permitting graft take comparable to that achieved with standard surgical techniques.",
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