Lasers present a unique light source with many clinical uses including a number of applications relevant to the lower extremity. In this article, the basic principles of lasers and their interactions with tissue will be reviewed. The article examines laser applications in skin and vascular disease including wound healing. The principles of laser safety are discussed, and relevant future developments are considered.
1. Maiman TH. Stimulated optical radiation in ruby. Nature1960;187:493-494.
2.
2. Katzir A. Lasers and optical fibres in medicine. San Diego: Academic Press; 1993.
3.
3. Goldman L, Blaney DJ, Kindel DJ, et al.Effect of the laser beam on the skin: preliminary report. J Invest Dermatol1963;40:121-122.
4.
4. Anderson RR, Parish JA. Microvasculature can be selectively damaged by using dye lasers: a basic theory and experimental evidence in human skin. Lasers Surg Med1981;1:263-266.
5.
5. Anderson RR, Parish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science1983;220:524-527.
6.
6. Alora MBT, Anderson RR. Recent developments in cutaneous lasers. Lasers Surg Med2000;26:108-118.
7.
7. Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol2003;49:1-31.
8.
8. Landthaler M, Ulrich H, Holenleutner S, et al.Role of laser therapy in dermatology—clinical aspects. Dermatology2004;208:129-134.
9.
9. Sommer S, Seukeran DC, Sheehan-Dare RA. Efficacy of pulsed dye laser treatment of port wine stain malformations of the lower limb. Br J Dermatol2003;149:770-775.
10.
10. Hsia J, Lowery JA, Zelickson B. Treatment of leg telangiectasia using a long-pulse dye laser at 595nm. Lasers Surg Med1997;20:1-5.
11.
11. Buscher BA, McMeekin TO, Goodwin D. Treatment of leg telangiectasia by using a long-pulse dye laser at 595nm with and without dynamic cooling device. Lasers Surg Med2000;27:171-175.
12.
12. Sadick NS, Prieto VG, Shea CR, et al.Clinical and pathophysiologic correlates of 1064-nm Nd: Yag laser treatment of reticular veins and venulectasias. Arch Dermatol2001;137:613-617.
13.
13. Proebstle TM, Lehr HA, Kargl A, et al.Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg2002;35:729-736.
15. National Institute for Clinical Excellence. Endovenous laser treatment of the long saphenous vein. Interventional Procedure Guidance 52. London: Author; 2004.
17. Okada M, Yoshida M, Tsuji Y. Clinical experience of endovascular laser intervention in cardiovascular disease. J Clin Laser Med Surg1998;16:249-254.
18.
18. Scheinert D, Biamino G. Femoropopliteal occlusions: experience with peripheral excimer laser angioplasty. Curr Interv Cardiol Rep2001;3:130-138.
19.
19. Gray BH, Laird JR, Ansel GM, et al.Complex endovascular treatment for critical limb ischaemia in poor surgical candidates: a pilot study. J Endovasc Ther2002;9:599-604.
20.
20. Topaz O, Das T, Dahm J, et al.Excimer laser revascularisation: current indications, applications and techniques. Lasers Med Sci2001;16:72-77.
21.
21. Huppert PE, Duda SH, Helber U, et al.Comparison of pulsed laser-assisted angioplasty and balloon angioplasty in femoropopliteal artery occlusions. Radiology1992;184:363-367.
22.
22. Lammer J, Pilger E, Decrinis M, et al.Pulsed excimer versus continuous-wave Nd: YAG laser versus conventional angioplasty of peripheral arterial occlusions: prospective, controlled, randomised trial. Lancet1992;340:1183-1188.
23.
23. Kilmer SL, Wheeland RG, Goldberg DJ, et al.Treatment of epidermal pigmented lesions with the frequency-doubled Q-switched Nd: YAG laser. A controlled, single-impact, dose-response, multicentre trial. Arch Dermatol1994;130:1515-1519.
24.
24. Tse Y, Levine VJ, McClain SA, et al.The removal of cutaneous pigmented lesions with Q-switched ruby laser and the Q-switched neodymium:yttrium-aluminium-garnet laser. A comparative study. J Dermatol Surg Oncol1994;20:795-800.
25.
25. Raulin C, Werner S, Greve B. Circumscripted pigmentations after iron injections—treatment with Q-switched laser systems. Lasers Surg Med2001;28:456-460.
26.
26. Grekin RC, Shelton RM, Geisse JK, et al.510-nm pigmented lesion dye laser. Its characteristics and clinical uses. J Dermatol Surg Oncol1993;19:380-387.
27.
27. Ashinoff R, Levine VJ, Soter NA. Allergic reactions to tattoo pigment after laser treatment. Dermatol Surg1995;21:291-294.
28.
28. England RW, Vogel P, Hagan L. Immediate cutaneous hypersensitivity after treatment of tattoo with Nd:YAG laser: a case report and review of the literature. Ann Allergy Asthma Immunol2002;89:215-217.
29.
29. Anderson RR, Geronemus R, Kilmer SL, et al.Cosmetic tattoo ink darkening. A complication of Q-switched and pulsed-laser treatment. Arch Dermatol1993;129:1010-1014.
30.
30. Ross EV, Yashar S, Michaud N, et al.Tattoo darkening and nonresponse after laser treatment: a possible role for titanium dioxide. Arch Dermatol2001;137:33-37.
31.
31. Mancuso JE, Abramow SP, Dimichino BR, et al.Carbon dioxide laser management of plantar verruca: a 6-year follow-up survey. J Foot Surg1991;30:238-243.
32.
32. Ross BS, Levine VJ, Nehal K, et al.Pulsed dye laser treatment of warts: an update. Dermatol Surg1999;25:377-380.
33.
33. Li Y, Yang K. Treatment of recalcitrant-pigmented flat warts using frequency-doubled Q-switched NdYAG laser. Lasers Surg Med2001;29:244-247.
34.
34. Pollock B, Sheehan-Dare R. Pulsed dye laser and intralesional bleomycin for treatment of resistant viral hand warts. Lasers Surg Med2002;30:135-140.
35.
35. Acland KM, Barlow RJ. Lasers for the dermatologist. Br J Dermatol2000;143:244-255.
36.
36. Alster TS. Laser treatment of hypertrophic scars, keloids and striae. Dermatol Clin1997;15:419-429.
37.
37. Wittenberg GP, Fabian BG, Bogomilsky JL, et al.Prospective, single-blind, randomized, controlled study to assess the efficacy of the 585nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in hypertrophic scar treatment. Arch Dermatol1999;135:1049-1055.
38.
38. Allison KP, Kiernan MN, Waters RA, et al.Pulsed dye treatment of burn scars. Alleviation or irritation?Burns2003;29:207-213.
39.
39. Borovoy M, Fuller TA, Holtz P, et al.Laser surgery in podiatric medicine—present and future. J Foot Surg1983;22:235-237.
40.
40. Lin YC, Su HY. A surgical approach to ingrown nail: partial matricectomy using CO2 laser. Dermatol Surg2002;28:578-580.
41.
41. Serour F. Recurrent ingrown big toenails are efficiently treated by CO2 laser. Dermatol Surg2002;28:509-512.
42.
42. Asawanonda P, Anderson RR, Chang Y, et al.308-nm excimer laser for the treatment of psoriasis: a dose-response study. Arch Dermatol2000;136:619-624.
43.
43. Feldman SR, Mellen BG, Housman TS, et al.Efficacy of the 308nm excimer laser for treatment of psoriasis: results of a multicentre study. J Am Acad Dermatol2002;46:900-906.
44.
44. Kalka K, Merk H, Mukhtar H. Photodynamic therapy in dermatology. J Am Acad Dermatol2000;42:389-413.
45.
45. Morton CA, Brown SB, Collins S, et al.Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group. Br J Dermatol2002;146:552-567.
46.
46. Spears J, Serur J, Shropshire D, et al.Fluorescence of experimental athromatous plaques with haematoporphyrin derivative. J Clin Invest1983;71:395-399.
47.
47. Schainfeld RM. Potential emerging therapeutic strategies to prevent restenosis in the peripheral vasculature. Catheter Cardiovasc Interv2002;56:421-431.
48.
48. Rockson SG, Lorenz DP, Cheong WF, et al.Photoangioplasty: an emerging clinical cardiovascular role for photodynamic therapy. Circulation2000;102:591-596.
49.
49. Mester E, Mester AF, Mester A. The biomedical aspects of laser application. Lasers Surg Med1985;5:31-39.
50.
50. Basford JR. Low intensity laser therapy still not an established clinical tool. Lasers Surg Med1995;16:331-342.
51.
51. Lucas C, Criens-Poublon LJ, Cockrell CT, et al.Wound healing in cell studies and animal model experiments by low level laser therapy; were clinical studies justified? A systematic review. Lasers Med Sci2002;17:110-134.
52.
52. Bihari I, Mester A. The biostimulative effect of low level laser therapy of long-standing crural ulcers using helium neon laser, helium neon plus infrared lasers, and non-coherent light: preliminary report of a randomized double-blind comparative study. Laser Ther1989;1:97-98.
53.
53. Gupta AK, Filonenko N, Salensky N, et al.The use of low energy photon therapy (LEPT) in venous leg ulcers: a double blind, placebo-controlled study. Dermatol Surg1998;24:1383-1386.
54.
54. Schindl A, Schindl M, Pernerstorfer-Schon H, et al.Diabetic neuropathic foot ulcer: successful treatment by low intensity laser therapy. Dermatology1999;198:314-316.
55.
55. Schindl M, Kerschan K, Schindl A, et al.Induction of complete wound healing in recalcitrant ulcers by low-intensity laser irradiation depends on ulcer cause and size. Photodermatol Photoimmunol Photomed1999;15:18-21.
56.
56. Malm M, Lundeberg T. Effect of low power gallium arsenide laser on healing of venous ulcers. Scand J Plast Reconstr Surg Hand Surg1991;25:249-251.
57.
57. Lundeberg T, Malm M. Low power HeNe laser treatment of venous leg ulcers. Ann Plast Surg1991;27:537-539.
58.
58. Lucas C, van Gemert MJ, de Haan RJ. Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomised clinical trial. Lasers Med Sci2003;18:72-77.
59.
59. Lagan KM, Clements BA, McDonough S, et al.Low intensity laser therapy (830nm) in the management of minor postsurgical wounds: a controlled clinical study. Lasers Surg Med2001;28:27-32.
60.
60. Lagan KM, McKenna T, Witherow A, et al.Low-intensity laser therapy/combined phototherapy in the management of chronic venous ulceration: a placebo-controlled study. J Clin Laser Med Surg2002;20:109-116.
61.
61. Flemming K, Cullum N. Laser therapy for venous leg ulcers (Cochrane Review). In The Cochrane Library, Issue 2, 2004, Chichester (UK): Wiley & Sons.
62.
62. Tulevski II, Ubbink DT, Jacobs MJ. Red and green laser Doppler compared with capillary microscopy to assess skin microcirculation in the feet of healthy subjects. Microvasc Res1999;58:83-88.
63.
63. Choi CM, Bennett RG. Laser Dopplers to determine cutaneous blood flow. Dermatol Surg2003;29:272-280.
64.
64. Clark S, Dunn G, Moore T, et al.Comparison of thermography and laser Doppler imaging in the assessment of Raynaud’s phenomenon. Microvasc Res2003;66:73-76.
65.
65. Micheels J, Alsbjorn B, Sorensen B. Clinical use of laser Doppler flowmetry in a burns unit. Scand J Past Reconstr Surg1984;18:67-73.
66.
66. Jeng JC, Bridgeman A, Shivnan L, et al.Laser Doppler imaging determines need for excision and grafting in advance of clinical judgement: a prospective blinded trial. Burns2003;29:665-670.
67.
67. Pape SA, Skouras CA, Byrne PO. An audit of the use of laser Doppler imaging (LDI) in the assessment of burns of intermediate depth. Burns2001;27:233-239.
69. Laboratory for Optical and Computational Instrumentation (LOCI). Retrieved May 7, 2004, from www.loci.wisc.edu/confocal/confocal.html.
70.
70. Anderson RR. Lasers in dermatology—a critical update. J Dermatol2000;27:700-705.
71.
71. Light lab imaging. Retrieved June 6, 2004, from http://octimaging.com/oct.html.
72.
72. Drexler W, Morgner U, Kartner FX. In vivo ultrahigh-resolution optical coherence tomography. Optics Lett1999;24(17):1221-1223.
73.
73. Sowa MG, Leonardi L, Payette JR, et al.Near infrared spectrocopic assessment of hemodynamic changes in the early post-burn period. Burns2001;27:241-249.
74.
74. Cobb J, Claremont D. Noninvasive measurement techniques for monitoring of microvascular function in the diabetic foot. Int J Lower Extr Wounds2002;1:161-169.
75.
75. Caspers PJ, Lucassen GW, Puppels GJ. Combined in vivo confocal Raman spectroscopy and confocal microscopy of human skin. Biophys J2003;85:572-580.
76.
76. UCL Medical Physics Department. Retrieved May 28, 2004, from http://www.medphys.ucl.ac.uk/research/mle/pa-imaging/pa-imaging.htm.
77.
77. Beard PC, Mills TN. Characterization of post mortem arterial tissue using time-resolved photoacoustic spectroscopy at 436, 461 and 532 nm. Phys Med Biol1997;42:177-198.
78.
78. Viator JA, Au G, Paltauf G, et al.Clinical testing of a photoacoustic probe for port wine stain depth determination. Lasers Surg Med2002;30:141-148.
79.
79. IEC 60825-1 Safety of laser products—part 1: equipment classification, requirements and user’s guide 2001. International Electrotechnical Commission: Geneva, Switzerland.
80.
80. Medical Devices Agency. Guidance on the safe use of lasers in medical and dental practice. London: Author; 1994.
81.
81. Sawchuk WS, Weber PJ, Lowy DR, et al.Infectious papilloma-virus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol1989;21:41-49.
82.
82. Garden JM, O’Banion MK, Shelnitz LS, et al.Papillomavirus in the vapour of carbon-dioxide laser-treated verrucae. JAMA1988;259:1199-1202.
83.
83. IEC TR 60825-8 Safety of laser products—part 8: guidelines for the safe use of medical laser equipment 1999. International Electrotechnical Commission: Geneva, Switzerland.
