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Co2 Laser
피부
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2918344/
| Dermatological conditions | Laser settings | Comments |
| Actinic and seborrhoeic keratoses | 4 to 7 watts super pulse mode | Topical local anesthesia applied under occlusion at lesions for 45 to 60 min prior to procedure. |
| Dermatosis papulosa nigra | 3.5 to 4.5 watts super-pulsed repeat mode with 0.1 second on and 0.1 second off | Procedure carried out after applying topical LA at each lesion under occlusion. |
| Warts | 9 to 15 watts continuous mode, continuous wave for common warts, use 4 to 6 watts superpulse for flat warts | Precede the vaporization of all types of warts with superficial vaporization of a 1-mm margin of normal skin at half the fluence, before treating the actual lesion, to reduce lesional recurrence. Filiform warts can be excised by vaporizing the base |
| Palmoplantar warts | 8 to 15 watts continuous mode, continuous wave | Precede the vaporization of all types of warts with superficial vaporization of a 1-mm margin of normal skin at half the fluence, before treating the actual lesion, to reduce lesional recurrence |
| Skin tags | 4.5 to 7.5 watts continuous mode | Cut the base of the lesion in focused cutting mode, and avulse the skin tag, in case of giant skin tags, exsanguinate the lesion by applying hemostats to peduncle of anesthetized lesion for 5 min prior to laser avulsion |
| Epidermal and dermal nevi | 4.5 to 7.5 watts super pulse mode | The procedure is repeated till the pigmented areas are visible. Do not go too deep to prevent scar formation |
| Intradermal and melanocytic nevi on face | 4.5 to 7.5 watts super pulse mode | Always send the excised specimen for histopathology and keep a close watch for recurrence for lesions with reported junctional activity. Review the patient on Days 30, 120, 360. If any pigment is noted at treated area, vaporize and repeat follow-up as above |
| Syringomas, angiofibroma, sebaceous hyperplasia, senile comedones | 4.5 to 6.5 watts super pulse mode | In case of syringomas, mark all the lesions with skin marking pen, as they will be rendered invisible after infiltration of anesthetic. The marks must be made with a thin-tipped surgical pen and must circumambulate each lesion |
| Scars | 2.5 to 4.5 watts super pulse mode | |
| Granuloma pyogenicum | 9 to 15 watts continuous mode, continuous wave | Coagulate the lesion including the cuff with slight defocusing to avoid puncturing the lesions which will lead to torrential bleeding. To attain hemostasis during the procedure, pinch the lesion between the thumb and index finger of the left, hand or apply tourniquet at proximal end |
| Earlobe keloids | 9 to 15 watts continuous mode, continuous wave for large earlobe lesions and 4 to 7 watts super pulse for smaller lesions | Follow up the patient at Day 3, 7, 14 and 30, and inject intralesional triamcinalone at site of healed keloids showing early signs of recurrence |
| Mucocele | 3.5 to 4.5 watts super pulse mode | Mark the outer border of the lesion with dotted lines |
| Pearly penile papules | 3.5 to 4.5 watts super pulse mode using single fixed pulses of 0.1 to 0.5 sec | |
| Nail bed reconstruction | 8 to 12 watts continuous mode | Mark the part of the nail to be avulsed with marker pen. Vaporize the nail in vertical fashion running from the proximal to distal end over the marked line. Separate the nail fold from the nail bed with nail elevator, separate proximal and lateral nail folds from nail plate with curved nail elevator. Avulse the part of the nail from the laser marked line to the lateral nail fold. Vaporize the overhanging mass of lateral nail fold tissue that contributes to onychocryptosis |
| Nail bed biopsy | 6.5 to 8.5 watts super pulse mode | Mark a round of 4 to 5 mm on the nail plate just above the site of biopsy. Perform the punch biopsy from the nail bed, the size being 1 mm lesser than the avulsed nail plate. Put back the circular piece of nail bed on the top of the biopsy area to seal the wound |
| Vulva Excision | 10 W | to minimize scarring and lateral thermal damage |
| Cervix | 20-30 W continuous d1.5-2mm | |
수술
The desired power-density range for adequate ablation or excision of cervical lesions with minimal thermal damage to adjacent areas is 750-2000 W/cm2 (generally, 20-30 W at a continuous setting), with an effective beam diameter of 1.5-2 mm to maximize ablation and hemostasis while minimizing lateral thermal damage. Super-pulse settings may also be used, and they are preferred by some to also reduce thermal damage.
The same laser settings may be used to coagulate an area being ablated or excised, but the overall power density delivered for coagulation may be reduced by enlarging the dot size or by reducing the watt setting on the laser, thus decreasing the watts used per cm2.
For treatment of the vagina or vulva/perianal area, 10 W is preferred to minimize scarring and lateral thermal damage.