Selective photothermolysis of blood vessels following flashlamp-pumped pulsed dye laser irradiation: in vivo results and mathematical modelling are in agreement.

Laser therapy using the pulsed dye laser is the standard treatment for port-wine stains (PWS). But the mechanism of action has not been elucidated completely, yet. The dorsal skin-fold chamber model in hamsters was used to investigate the effects of laser treatment (lambda(em)=585 nm; pulse duration: 0.45 ms; fluence: 6 J per cm2) on blood vessels. Vessels (n=3394) were marked with FITC dextran (MW 150 kDa) and diameters (2-186 microm) were measured using intravital fluorescence microscopy up to 24 h following irradiation. Histology (H&E, TUNEL, CD31) was taken 1 or 24 h after irradiation. The experimental results were compared with the predictions of a mathematical model based on the finite-element method. Following irradiation treatment the number of unperfused vessels decreases with decreasing vessel diameter in vivo. Histology indicated a restriction of tissue injury to the irradiated area after 1 h. Blood vessels contained aggregated red blood cells. After 24 h tissue damage occurred also outside the irradiated area and thrombus formation was visible. These results were in agreement with the mathematical calculations. In addition to initial physical effects after pulsed dye laser treatment delayed biological processes contribute significantly to the reduction of perfused blood vessels. Because of incomplete photocoagulation of smaller blood vessels (diameter 2-16 microm) a complete bleaching of PWS seems to be unlikely.