Clinical experience in treatment of port-wine stain with KTP 532 nm laser

Abstract

2005

Latkowski IT, Wysocki MS, Siewiera IP.

Kliniki Chirurgii Plastycznej w Polanicy Zdroju Akademii Medycznej we Wroclawiu, oraz ze Szpitala Chirurgii Plastycznej w Polanicy Zdroju. latkowski@chp.pl

Lesions of port-wine stain (PWS) type are the most commonly occurring vascular malformations of the skin which concerns about 0.3% of the population. These important from aesthetic and psychological points of view capillaries malformations have always been difficult for treatment. Previously applied methods consisting in cryosurgery, dermabrasion, radiation therapy or surgery and skin grafting produced unsatisfactory results. It was only when highly selective lasers were introduced that PWS could be treated effectively and safely. A lot of available lasers and lack of experience of the health care providers result in not always proper qualification of the lesions to the given laser type. The aim of the study was to present a prospective analysis of the efficacy of treatment of PWS vascular malformations by means of KTP 532 nm laser. From January 2003 to May 2005, 155 patients (115 women, 40 men) aged from 2 to 62 years (mean age 18.23) were treated by means of laser at the Plastic Surgery Hospital in Polanica Zdroj, Poland. In the investigated population, the vascular malformation was a component of Sturge-Weber syndrome in 7 patients, Klippel-Trenaunay syndrome--in 2 patients, while in one case it accompanied Recklinghausen disease.

The vascular lesions had not been treated before in majority of cases, while in 37 patients the laser therapy was the continuation of other previously attempted treatment, which included excision and skin grafting, argon laser therapy, radiation therapy and pulsed dye laser treatment. The procedures were performed with at least 4-week intervals without, or under local and in children general anaesthesia. Therapeutic efficacy was evaluated independently by 3 surgeons and a photographer on the basis of Subjective Scoring System (SSS) comparing simultaneously shown pictures of the patients taken prior to and after the last procedure. The outcomes of treatment were classified according to a 4-degree scale: excellent outcome--75-100% improvement, with 100% perceived as eradication of the lesion; good--50-74% improvement; fair--25-49% improvement and poor--less than 25% improvement, including no observable improvement. In 81% of the lesions (126 patients) treatment with KTP 532 nm laser produced significant improvement which was found satisfactory by the patient. excellent outcome of treatment was obtained in 49 patients (31%), good in 42 (27%), fair in 35 (23%).

However, despite many laser treatments using various energy and pulse duration, there was almost not observable improvement in 19% of the study population (29 patients). The PWS which failed to treatment were most commonly located on the limbs. The results of treatment was poor in 74% of malformations which were located beyond the face and neck (all of them were on the limbs). There was no episodes of scarring or persistent pigmentary changes in any of the patients.

CONCLUSIONS:

1. KTP (532 nm) laser is an effective and safe tool in the management of capillary malformations of PWS type. 2. The treatment is especially effective in adults and in lesions localized to the face and neck area. 3. Port-wine stain localized on the trunk and extremities often appears to be KTP laser resistant.PMID: 16425790

[PubMed - in process]