Oni Georgette, Robbins Daniel, Bailey Steven, Brown Spencer A, Kenkel Jeffrey M
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9132, USA.
Lasers Surg Med. 2012 Jan;44(1):4-10. doi: 10.1002/lsm.21150. Epub 2012 Jan 3.
Studies examining the histopathological changes that occur in human skin following fractional laser treatment have been performed mainly in animals or abdominal tissue prior to abdominoplasty. This study looks at the effect of double pulse fractional CO(2) laser compared to single pulse treatments to assess differences in tissue injury in the face and abdomen.
Twelve healthy subjects randomized into two groups, had two 1 cm(2) areas (infraumbilical and forehead) treated with the fractional CO(2) laser (Deep Fx, Lumenis). Settings used were 15 mJ double pulse, and 30 mJ single pulse, 300 Hz, 10% density and compared to the historic control of 15 patients treated at 15 mJ single pulse [Bailey et al. (2011), Lasers Surg Med 43: 99-107]. Treated sites were biopsied and analyzed with H&E and TUNEL staining to measure width and depth of the microthermal zones (MTZ) of ablation.
When comparing 15 mJ double pulse to single pulse there were significant differences both in depth (abdominal skin, P = 0.002 and facial skin, P = 0.001) and width (facial skin, P = 0.0002) of MTZ. When comparing double pulsing at 15 mJ with single pulsing at 30 mJ there were significant differences between MTZ depths in the abdomen (P < 0.01) but not in either the MTZ depth (P = 0.69) or the width in the face (P = 0.502).
This study demonstrates the differences between histopathological laser injury patterns in the face compared to the abdomen when single pulsing is used. It also demonstrates that double pulsing at 15 mJ is statistically similar to single pulsing at 30 mJ in the face. We think this could have ramifications for clinical practice where by double pulsing at lower energies may result in better clinical outcomes than increasing energies or using multiple passes at single pulse. Clinical studies needs to be performed to investigate this further.
关于分次激光治疗后人体皮肤组织病理学变化的研究主要在动物或腹部整形术前的腹部组织中进行。本研究观察了双脉冲分次二氧化碳激光与单脉冲治疗的效果，以评估面部和腹部组织损伤的差异。
将12名健康受试者随机分为两组，用分次二氧化碳激光（Lumenis公司的Deep Fx）对两个1平方厘米的区域（脐下和前额）进行治疗。使用的参数为15毫焦双脉冲、30毫焦单脉冲、300赫兹、10%的密度，并与15名接受15毫焦单脉冲治疗的患者的历史对照数据[Bailey等人（2011年），《激光外科与医学》43:99 - 107]进行比较。对治疗部位进行活检，并用苏木精-伊红（H&E）染色和末端脱氧核苷酸转移酶介导的缺口末端标记（TUNEL）染色分析，以测量消融微热区（MTZ）的宽度和深度。
比较15毫焦双脉冲与单脉冲时，MTZ的深度（腹部皮肤，P = 0.002；面部皮肤，P = 0.001）和宽度（面部皮肤，P = 0.0002）均存在显著差异。比较15毫焦双脉冲与30毫焦单脉冲时，腹部MTZ深度存在显著差异（P < 0.01），但面部MTZ深度（P = 0.69）或宽度（P = 0.502）均无显著差异。
本研究证明了使用单脉冲时面部与腹部组织病理学激光损伤模式的差异。还证明了15毫焦双脉冲在面部与30毫焦单脉冲在统计学上相似。我们认为这可能会对临床实践产生影响，即较低能量的双脉冲可能比增加能量或单脉冲多次照射产生更好的临床效果。需要进行临床研究以进一步调查此事。
