In modern dermatocosmetology, the use of lasers is extremely common. This technology of surgical correction helps to cope with a number of various skin pathologies. It is also worth noting that laser correction is quite simple, provided that it is performed by a professional, and is not very expensive. But with all the advantages and simplicity of its execution, laser correction is accompanied, like any other procedure, by the risk of developing a number of complications. Therefore, today Estet-portal will talk about the causes and factors influencing the occurrence of complications in this technique of corrective surgery.

Field of laser application and its types

All types of laser surgical interventions in dermatology and cosmetology can be conditionally divided into two types: operations during which the affected skin area is removed, including the epidermis, and interventions that selectively target the elimination of pathological structures without damaging the epidermis. The results of operations of the first type (ablative) are closer to what we used to understand as classical surgery.

In this variant, laser radiation, more or less equally absorbed by all layers of the skin, at a sufficiently high energy leads to ablation (ablatio - melting, blurring; in our case - removal, amputation).

Most often, a CO2 laser operating at a power of 15–25 W is used to solve this problem. With a minimum beam projection diameter on the surface, this mode provides a power density of 50–100 kW/cm2 - continuous mode, or continuous wave (CW) mode. Under such conditions, large vascular tumors, keloid scars, large condylomas of any localization are removed, some manipulations on the nails (ingrown nail) are performed.

The CW mode of a CO2 laser is sometimes used not only for block excision, but also for layer-by-layer "evaporation" (vaporization) of pathological tissue, which is achieved by reducing the power density due to beam defocusing. It is in this way that potentially malignant tumors (basalioma, erythroplasia of Queyrat, actinic cheilitis), as well as a number of benign skin neoplasms (NOCs) are eliminated:

  • angiofibroma;
  • syringoma;
  • trichoepithelioma;
  • neurofibroma;
  • large postoperative scars;
  • inflammatory skin diseases and malformations (facial skin granuloma, finger cyst, sebaceous gland cyst, hair cyst, sweat gland cyst);
  • infectious skin lesions (vulgar warts, plantar warts, recurrent warts);
  • vascular neoplasms (pyogenic granuloma, angiokeratoma, cavernous hemangioma, annular lymphangioma);
  • Formations that cause cosmetic defects (rhinophyma, deep acne scars, epidermal nevi, lentigo, xanthelasmas, some tattoos).

lazernaya-khirurgiya-v-praktike-dermatokosmetologa-kak-predupredit-oslozhneniya

Possible causes of laser complications

In a broad sense, the causes of all complications that can be observed due to the use of lasers for the treatment of NOCs can be conditionally divided into causes of endogenous and exogenous causes.

The first can include all the initially present features of the patient's body (pathological and non-pathological) that can directly affect the course of the surgical intervention itself and the adequacy of the course of the postoperative reparative process. All of them, in turn, can be divided into general and local.

Endogenous risk factors for complications

Assessing the significance of common endogenous risk factors for the development of intraoperative and postoperative complications and without dwelling on each of them in detail, we only note that all of them are well known and are always taken into account in general surgical practice, but often escape the attention of a laser cosmetic surgeon. These are, first of all, the following:

  • hormonal disorders (diabetes mellitus, hyperthyroidism, hyperaldosteronism);
  • blood coagulation disorders;
  • immune disorders (immunodeficiencies);
  • allergy;
  • hereditary, infectious, tumor processes;
  • systemic syndromes and diseases (for example, connective tissue dysfunction leading to the formation of hypertrophic and keloid scars), etc.

In addition, there are a number of dynamic and non-pathological conditions of the body that can cause quite serious complications that develop after laser intervention. In particular, we are talking about seasonal UV-induced or drug-induced periods of activation of the melanocytic system (postoperative hyperpigmentation), cyclic changes in the activity of the blood coagulation system in women (intraoperative bleeding), etc.

It is necessary to dwell in more detail on local risk factors for the development of complications of laser surgical treatment of NOC. These primarily include the characteristics of the formation itself to be removed.

  1. Linear dimensions of the NOC (according to our observations, with laser wound sizes up to 1 cm2, the probability of postoperative scar formation is 50%, up to 2 cm2 - 70%, > 3 cm2 - 100%, provided that the skin layers located below the epidermis are destroyed) .
  2. The depth of the tumor in the skin (when the size of the laser wound is > 1 cm2, the probability of formation of a postoperative scar is directly proportional to its depth. Damage to the basement membrane > 1 cm2 is a direct risk of postoperative hypopigmentation).
  3. Etiology of NOC. The viral nature of the origin of many neoplasms and their inherent pathomorphological picture, characterized by penetration into the lower layers of the skin, implies a deep excision of such tumors in order to avoid relapses. This accordingly increases the likelihood of complications such as bleeding, pigmentation disorders, scarring.
  4. Nosological form of NOC, which determines the initial degree of goodness of the removed tumor (benign, conditionally benign, locally destructive, malignant). It is obvious that in some cases, the issues of cosmetic rehabilitation may fade into the background due to the need to expand the scope of the operation in order to ensure its radicalization.
  5. Localization of the NOC. Removal of tumors in areas of active blood supply poses a risk of developing acute and recurrent hemorrhages. These are the following zones: face, scalp, genital area, perineum, perianal area. During operations in the last three zones, among other things and for obvious reasons, the risk of infection of the postoperative wound increases. Particular care is required for operations to remove tumors in the immediate vicinity of the natural openings (anus, external opening of the urethra, lip, etc.) of the glandular ducts (ducts of the salivary glands, lacrimal duct, duct of the Bartholin gland, etc.). In these situations, there is a high risk of developing both early and late postoperative complications (formation of retention glandular cysts, their infection and suppuration, functional disorders), in the first case due to acute postoperative edema, in the second case due to cicatricial atresia. Some caution is required for operations in areas of probable mechanical trauma and irritation - skin folds, areas of close contact with clothing.
  6. Type of NOC blood supply. This refers to the presence or absence of a main feeding vessel that can be a source of massive bleeding both directly during the operation and some time after it (with trauma or resorption of the blood clot). According to our observations, among NOCs of epithelial origin, the main type of blood supply can most often be found in plantar warts (up to 60% of cases), giant molluscum contagiosum (up to 50% of cases), atypical keratoacanthoma and nodular forms of basal cell skin cancer (up to 30% of cases); among connective tissue tumors - in dermatofibromas (about 20%), solid fibromas (at least 10% of cases).
    7. The condition of the skin in the area of ​​the NOC. Underlying skin diseases are implied, which, on the one hand, can affect the healing of a postoperative laser wound, and on the other hand, can be triggered by exposure to laser radiation: acute and chronic inflammatory skin diseases, atopy, precancerous processes, etc.
Exogenous risk factors for complications

Exogenous causes of complications of the surgical treatment of NOC can be divided into two large groups: complications caused by the patient's non-compliance with the doctor's recommendations on the tactics of managing a postoperative laser wound, and complications caused by a violation of the principles and tactics of the rational use of laser technology during operations for NOC ( inadequate choice of treatment method, incorrect calculation of laser exposure modes, imperfection of the technique for performing the procedure, etc.).

Thus, as follows from the above, the risk factors for complications of laser surgery performed for NOC are very diverse. They can cause failures at all stages of treatment: during surgery, in the next few hours and days after it, after a long period of time. In this regard, it is appropriate to divide these complications into the following categories: intraoperative complications, early and late postoperative complications.

    Intraoperative complications:
    1. acute bleeding;
      • acute lymphorrhea;
      • acute deep and/or widespread superficial tissue burn;
      • damage to surrounding tissues and organs (reversible and irreversible, with or without impaired function).
    2. Early postoperative complications:
    2. local and regional edema, including acute allergic edema;
      • extensive postoperative necrosis;
      • hematomas (infected, uninfected);
      • secondary bleeding;
      • lymphorrhea, lymphostasis;
      • infectious inflammation of the wound (limited and unlimited, including erysipelas, phlegmon, etc.);
      • lymphoadenitis, lymphangitis;
      • early relapse;
      • early dissemination;
      • activation of background diseases.
    3. Late postoperative complications:
    3. formation of strictures, cicatricial deformities;
      • formation of hypertrophic and keloid scars;
      • atresia of natural orifices and glandular ducts;
      • formation of retention, including glandular cysts (with suppuration, without suppuration);
      • hyper- and hypopigmentation;
      • paresthesia, impaired skin sensitivity in the area of ​​operation and along the damaged branch of the cutaneous nerve;
      • lymphostasis;
      • late relapses and dissemination;
      • metastasis;
      • loss of function of organs and tissues in the area of ​​surgical intervention (partial, complete).
Summing up, it is worth paying attention to the fact that in the absolute majority of cases, complications in laser surgery for NOC arise due to an error by doctors when assessing the status of the patient or the nature of the disease, or by choosing the wrong treatment tactics.

It should not be forgotten that laser surgery in general and laser surgery of NOC in particular, belonging to one of the youngest branches of the surgical specialty, not only obey all the rules adopted in traditional surgery and oncology, but also have a number of specific features associated with the unique capabilities of laser technology, which can provide the desired result only if it is used competently and professionally.

According to www.lvrach.ru

Add a comment

captcha

RefreshRefresh