No abstract

The hypothesis that smaller and more deeply placed CVM vessels respond poorest to laser treatment is supported by these findings. Moreover, the DMV provides a simple non-invasive technique for demonstrating this.

Modern lasers allow different parameters to be altered in an effort to gain further improvement in otherwise resistant capillary vascular malformations (CMs). The aim of this study was to examine the effect of changing the pulse duration, wavelength, spot size, and fluence on the color and capillary architecture of 585-nm pulsed-dye, laser-resistant CMs. Eighteen patients were assessed with a depth measurement videomicroscope (DMV) before and after 12 test patches with ScleroPlus and V-Beam lasers at specified parameters. In the majority of the test patch areas, there was little improvement after treatment. However, 44% of patients had greater than 75% clearance in at least 1 test patch site. This study demonstrates that both lasers can achieve further lightening in 585 nm 0.45 msec pulsed-dye laser-resistant CMs. However, in CMs consisting of small-diameter deep vessels, further improvement is unlikely.

The authors found that vessels with a diameter greater than 50 mum were adequately treated, whereas those smaller than 50 microm appeared resistant to laser treatment. These data would suggest that pulse durations longer than 0.45 msec are not required to treat large ectatic capillary vascular malformation vessels. The authors suggest that the failure to treat very-small-diameter vessels is attributable to thermal dissipation from the target vessels, whose thermal relaxation time is much shorter than the pulse duration of the laser used.

This case report describes the use of a double-free, flow-through flap as a valuable tool in reconstruction following oncological resection of a large, fungating, squamous cell carcinoma extending through the scalp, forehead, skull, and dura. An anterolateral thigh flap was utilized to supply: soft tissue for the forehead reconstruction, vascularized fascia lata for the dural repair, and to act vascular conduit to supply a distally placed latissmus dorsi flap for total scalp reconstruction. We believe this is the first time this combination of double-free, flow-through flap design has been published for the reconstruction of complex, composite scalp and calvarial defects.