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Flash Pulse Dye Laser (595nm) Therapy on Facial Capillary Malformation

This video teaches its viewers about facial capillary malformations, possible sequelae, as well as a treatment option, flash pulse dye laser.

Authors: Maya Merriweather, BS and Richter T. Gresham, MD FACS

Email: mmerriweather@uams.edu and GTRichter@uams.edu

Institutions: University of Arkansas for Medical Sciences and Arkansas Children’s Hospital

Laser eye protection was secured on the patient, surgeon and observers. A cheek, chin and lower lip capillary malformation was treated with 595-nm flash pulsed dye laser (PDL) on a pediatric patient for their yearly maintenance. The targeted area measured 25cm2. During the first pass the fluence was set at 9J/cm squared for a pulse duration of 1.5ms. The spray/delay cool setting was set to 40/20. The setting of the fluence and pulse duration were changed to 8.J/cm2 and 0.45ms respectively for a second pass allowing for complete coverage of the lesion. Assessment of the capillary malformation was assessed with digital photographs.
Flash pulse dye (PDL) at 585-595nm can be used as primary therapy for capillary malformations to prevent discoloration, growth and deformity.
Infections or inflammatory conditions of the affected skin. Avoid use the laser on areas of acute infections. Caution in dark (Fitzpatrick scale IV – VI) skin individuals as could lead to hypopigmentation.
Patient was sedated with general anesthesia in a sterile environment. Eye protection was given to all observers, patient, and surgeon.
In children with V1 facial distribution of the capillary malformation they should be evaluated for conditions associated with Sturge Weber Syndrome including an MRI of the brain to rule out meningeal involvement and Ophthalmology consult to rule out glaucoma. Full dermal examination should be performed for any other vascular lesions. Examine for associated hypertrophic conditions.
Caution and lower laser settings should be performed along vermilion border.
Advantages: Primary benefit of using the PDL is to disrupt the abnormal capillary beds and lighten the discolored skin. A second pass with variation in pulse duration will target different depths of the lesion. Disadvantage: PDL treatment is unlikely to result in complete resolution.
Blistering, hypopigemntation, and hyperpigementation. Midline facial capillary malformations can be resistant to laser therapy.
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Thank you Dr. Richter for giving me the opportunity to perform research under your guidance. I have learned a lot about my subject matter, and the field of Otolaryngology. It was a pleasure working with you!
“Capillary Malformation: Boston Children's Hospital.” Boston Childrens Hospital, www.childrenshospital.org/conditions-and-treatments/conditions/c/capillary-malformation.   “Capillary Malformations.” Edited by Kiersten Ricci, Cincinnati Childrens, Feb. 2020, www.cincinnatichildrens.org/health/c/capillary.  Cole, Patrick D, et al. “Laser Treatment of Pediatric Vascular Lesions.” Seminars in Plastic Surgery, Thieme Medical Publishers, 21 Aug. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2884839/.  Rosenberg, Tara L., and Gresham T. Richter. “Lasers in the Treatment of Vascular Anomalies.” Current Otorhinolaryngology Reports, vol. 2, no. 4, 21 Sept. 2014, pp. 265–272., doi:10.1007/s40136-014-0065-6. 

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