Abstract
Laser cartilage reshaping (LCR) with cryogen spray cooling is a promising modality for producing cartilage shape change while reducing cutaneous thermal injury. However, LCR in thicker tissues, such as auricular cartilage, requires higher laser power, thus increasing cooling requirements. To eliminate the risks of freeze injury characteristic of high cryogen spray pulse rates, a carbon dioxide (CO2) spray, which evaporates rapidly from the skin, has been proposed as the cooling medium. This study aims to identify parameter sets which produce clinically significant reshaping while producing minimal skin thermal injury in LCR with CO2 spray cooling in ex vivo rabbit auricular cartilage. Excised whole rabbit ears were mechanically deformed around a cylindrical jig and irradiated with a 1.45-μm wavelength diode laser (fluence 12–14 J/cm2 per pulse, four to six pulse cycles per irradiation site, five to six irradiation sites per row for four rows on each sample) with concomitant application of CO2 spray (pulse duration 33–85 ms) to the skin surface. Bend angle measurements were performed before and after irradiation, and the change quantified. Surface temperature distributions were measured during irradiation/cooling. Maximum skin surface temperature ranged between 49.0 to 97.6 °C following four heating/cooling cycles. Significant reshaping was achieved with all laser dosimetry values with a 50–70 °C difference noted between controls (no cooling) and irradiated ears. Increasing cooling pulse duration yielded progressively improved gross skin protection during irradiation. CO2 spray cooling may potentially serve as an alternative to traditional cryogen spray cooling in LCR and may be the preferred cooling medium for thicker tissues. Future studies evaluating preclinical efficacy in an in vivo rabbit model are in progress.
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Acknowledgments
The authors thank the American Society for Laser Medicine and Surgery (2010 Student Research Grant to Mr. Wu and Dr. Horace Furumoto Innovations Award to Dr. Jia), the Department of Defense (DR090349, Deployment Related Medical Research Program to Dr. Wong), the National Institute for Dental and Craniofacial Research (1R21DE019026 to Dr. Wong), and the National Institutes of Health (AR59244, Laser Microbeam and Medical Program to Dr. Nelson) for providing funding support for this study. The authors also acknowledge institutional support from the Beckman Laser Institute Endowment and the Packard Foundation.
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J. Stuart Nelson, MD, PhD has intellectual property rights with Syneron/Candela Corporation. The remaining authors report no conflicts of interest or financial disclosures. This study was presented as an oral and poster at the 2011 American Society for Laser Medicine and Surgery Annual Conference in Grapevine, TX.
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Wu, E.C., Sun, V., Manuel, C.T. et al. Ex vivo investigations of laser auricular cartilage reshaping with carbon dioxide spray cooling in a rabbit model. Lasers Med Sci 28, 1475–1482 (2013). https://doi.org/10.1007/s10103-012-1250-9
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DOI: https://doi.org/10.1007/s10103-012-1250-9