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A Comparison Between Dermatomal Excision and Pulsed Carbon Dioxide Laser Ablation

Howard A. Green, MD; Elizabeth Burd, MB, ChB, FRCS; Norman S. Nishioka, MD; Ulrich Brüggemann, Dipl Ing; Carolyn C. Compton, MD, PhD

Arch Dermatol. 1992;128(5):639-645.

Abstract
• Background.—
Continuous-wave carbon dioxide lasers are not widely used for the surgical removal of most skin lesions because it is difficult to control laser ablation and the extensive laser-induced thermal damage slows healing. Pulsed lasers provide means to reduce thermal damage produced during laser ablation and permit precise control of tissue removed during ablation. Using a swine model, we compared on a gross and microscopic level the healing of middermal wounds of similar depth and area created by a dermatome and a focused pulsed CO₂ laser.

Results.—

Pulsed CO₂ laser ablation removed skin precisely and bloodlessly with 85 ±15 µm (mean ±SD)of residual thermal damage covering the surface of the wound. Compared with the dermatome, tissue reepithelialization was delayed in the laser wounds at day 3. By day 7, epithelial coverage of the laser-created wounds was not significantly different from the dermatome-created wounds. No significant difference in the appearance of the two wounds was noted at 42 days.

Conclusions.—
We conclude that the focused pulsed CO₂ laser is capable of precisely and bloodlessly ablating skin with conservation of residual subjacent adnexal elements, minimal early interference with epibolic epithelial outgrowth, and no pathologic effects on the wound healing process. Pulsed CO₂ lasers may be a valuable instrument for the conservative ablation of skin and skin lesions.

(Arch Dermatol. 1992;128:639-645)

Author Affiliations
From the Department of Dermatology, Harvard Medical School and Massachusetts General Hospital, Boston, Mass (Dr Green); the Department of Histopathology, Bristol (England) Royal Infirmary (Dr Burd); Harvard Medical School, Wellman Laboratories of Photomedicine, Massachusetts General Hospital (Dr Nishioka and Mr Brüggemann); and Department of Pathology, Massachusetts General Hospital, Shriners Burn Institute (Dr Compton), Boston, Mass.

Footnotes
Accepted for publication September 11, 1991.

Read in part before the American Burn Association National Meeting, Las Vegas, Nev, March 28, 1990.

Reprint requests to Department of Dermatology, Harvard Medical School, Wellman 2, Massachusetts General Hospital, Boston, MA 02114 (Dr Green).

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