Light Amplification by Stimulated Emission of Radiation (LASER)

CO2:
Wavelength = around 9.4 to 10.6 micrometers (primarily 10.64 microns)
o Water absorbs this frequency of light very well therefore superficial absorption (useful in sx)
Advantages:
o Thermal precision- max impact on target and min damage to other tissue
o Absolut hemostasis <0.5mm diameter
o Accelerated healing of tissue- lack of mechanical trauma
o Minimal post op pain- sealing axonal tubules in small cutaneous nerves
o Sterilization of target sight- inactivate bacteria, fungi, or virus
Procedures used in Podiatry
o Plantar Verruca Ablation
o Porokeratoma Ablation
o Nail Matrixectomy Ablation
o Fungal Nail Treatment
o Heel Fissure Debridement/Ulcer Debridement/Sterilization
o Incisional Procedures for soft tissue component (of neuroma, bunion, etc.)
o Keloid and hypertrophic scar treatment- lack of fibroblast stimulation

Nd:YAG lasers: (neodymium-doped yttrium aluminum garnet)

Wavelength = 1.064 microns: 1060 nm
o Poorly absorbed by hemoglobin, chromophores, protein, or water
o 99% of Podiatric use is with contact laser scalpels
Advantages:
o Fast dissection, seals small nerves/vessels, cell necrosis is min, high precision, cuts w/light energy
Procedures in Podiatry
o Nerve releases and neuromas, neurectomy, bunionectomy (soft tissue), ganglions, tendon
transplants/lengthening, heel spur (soft tissue), plantar fasciotomy, dissection
Used in:
o Situations contraindicating tourniquet particularly where a dry field is essential
o Dissection of delicate tissue planes
o Patients where surgical trauma may stimulate adverse reactions
Cutera- FDA clearance for the temporary increase of clear nail in patients with Onchomycosis

Argon system
Wavelength (dual output: Blue- 488nm, Green 514nm)
o Indicated for tissue coagulation and necrosis procedures (acisional)
o 1-2 mm penetration depth
o Argon passes epidermis to absorb in the dermal hemoglobin selectively
Object = delivery of energy to the superficial dermis (papillary plexus)- vessels feeding the wart
o Absorption is first absorbed in the hemoglobin of the reticular dermisvessels are stenosed via selective
photoablationAble to coagulate vessels less than 1 mm in diameter
Advantages
o Minimal exposure to blood
o Decreased laser plume
o Good treatment for immunocompromised patients
o Faster than CO2 laser
Procedures in Podiatry-
o Large verrucae on the plantar aspect of the foot and the posterior aspect of the heel
o Multiple disseminating lesions or mosaic warts on the plantar foot
o Vascular lesions of a superficial nature
o Patients having communicable diseases when a bloodless field is desired
J Am Acad Dermatol. 1990 Jul;23(1):115-20., J Drugs Dermatol. 2012 Apr;11(4):496-504.
Sznelewski, Piotr. "A Safe, Non-ablative Method of Removing Common Warts Using a 1470 Nm Diode Laser: Results of an 18-month Follow-up of First Patients." Journal of Foot and Ankle Surgery 24.6
(n.d.): 431-37. Print. Wasserman, Gerald, "Treatment of Morton's Neuroma with the Carbon Dioxide Laser", Clinics in Podiatric Medicine and Surgery, vol. 9, no. 3, July 1992.
Carlson, Bruce A., and Pyrcz, Robert A., "Lasers in Podiatry and Orthopaedics", Nursing Clinics of North America, v. 25, No. 3, Pg. 719-723.

Crozer Chester Medical Center