The depth measuring videomicroscope (DMV): A non‐invasive tool for the assessment of capillary vascular malformations

Sivarajan, V. V.; Mackay, Iain R.

doi:10.1002/lsm.10223

Cited by 22 publications

(26 citation statements)

References 31 publications

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“…Capillary depth and diameter were measured with a compact videomicroscope attached to a 200Â Cy-scope lens (PW Allen, Tewkesbury, UK), using the depth and diameter measuring videomicroscopy (DMV) technique as previously described [16,17]. CM colour changes were assessed using Munsell colour charts (GretagMacbeth, New Windsor, NY) [16,[18][19][20].…”

Section: Measurementsmentioning

confidence: 99%

“…CM colour changes were assessed using Munsell colour charts (GretagMacbeth, New Windsor, NY) [16,[18][19][20]. Colour measurements using the colour charts were carried out by a single observer in standardised lighting conditions and following 20 minutes acclimatisation to room temperature, to exclude potential sources of error and allow detection of genuine changes in CM colour following treatment.…”

Section: Measurementsmentioning

confidence: 99%

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A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations

2008

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Alexandrite laser treatment was the most effective, but resulted in hyperpigmentation and scarring in four patients, probably due to its deeper penetration and lower specificity for oxyhaemoglobin causing non-specific dermal damage. Double passing of the PDL can result in further CM fading even in previously treated patients. Videomicroscopy measurements of capillary diameter before treatment may be predictive of the likelihood for patient's to respond to laser treatment.

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Section: Measurementsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations

2008

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“…It is hypothesized herein that the remaining vessels responsible for the red-pink coloration are difficult to destroy due to their small diameters (10-30 mm) [6][7][8] because smaller vessels have a much lower blood volumeto-vessel wall (perivascular) surface area than larger vessels [9]. This results in insufficient thermal confinement within the vessel and further decreases treatment efficiency.…”

Section: Introductionmentioning

confidence: 99%

Laser surgery of port wine stains using local vacuum pressure: Changes in skin morphology and optical properties (Part I)

et al. 2007

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Background and Objectives: In a recent case study, the use of a suction device to aid in port wine stain (PWS) laser treatments showed favorable results. It is our objective to further understand the mechanisms of vacuum-assisted laser therapy by analyzing the mechanical and optical changes of the skin and musculoskeletal tissues during the application of mild vacuum pressure from a suction cup. Study Design/Materials and Methods: A mathematical model of tissue deformation was used to determine the changes in tissue morphology that affect the underlying laser-tissue interactions, such as epidermal stretching and thinning, blood vessel dilation, and change in blood vessel depth. Video imaging experiments were used to verify the bulk tissue deformation and skin surface stretching computed by the mathematical model. Additionally, visible reflectance spectroscopy was used to determine the changes in the optical characteristics of tissue, including blood vessel dilation and epidermal absorption coefficient. Results: At a vacuum pressure of 50 kP a , the epidermis at the center of the suction cup was measured to stretch 4% and was calculated to be thinned approximately 6%. Blood vessels embedded in the dermis were measured to dilate up to two times their original size. However, these vessels were calculated to be displaced toward the skin surface by a very small amount, approximately 1-3 mm. The absorption coefficient of the epidermis was also measured to be reduced significantly by approximately 25% at a wavelength of 585 nm. Conclusions: Mild vacuum pressure applied to the skin surface causes considerable changes in the morphology and optical properties of the tissue. These changes may be used for more efficient photothermolysis of small PWS blood vessels.

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“…However, complete PWS removal is rare even after multiple treatments: most patients obtain a variable amount of PWS blanching and, subsequently, the lesion stabilizes at a red pink color showing little or no improvement despite further laser treatments [4][5][6]. Clinical studies evaluating the relationship between therapeutic outcome and PWS morphology and anatomic location have found that smaller diameter and deeply located vessels respond poorly to laser treatments: Fiskerstrand et al [7] reported a PWS vessel mean diameter and depth of approximately 20 and 250 mm, respectively, in patients that responded poorly to PDL; Sivarajan and Mackay [8] reported a reduction in vessel mean diameter from 70 to 40 mm and increased vessel depth from 70 to 85 mm after PDL treatment; the same authors [9] also reported that vessels with diameters of 10-50 mm remained after PDL treatment, while vessels with larger diameters were successfully photocoagulated. Babilas et al [10] reported incomplete photocoagulation in vessels of 2-16 mm diameter after PDL irradiation of hamster microvasculature.…”

Section: Introductionmentioning

confidence: 99%

“…Although the biological and physical mechanisms of PWS vessel injury remain incompletely understood, a possible mechanism of damage postulates that if the irradiation energy absorbed by hemoglobin is sufficient to increase the vessel wall temperature to 708C then thermal denaturation occurs [4,8]. In order to confine thermal damage to the vessel, a pulse duration less than the thermal relaxation time (duration for which half of the deposited energy has been lost due to heat diffusion) of the target vessel should be used (usually on the order of milliseconds).…”

Section: Introductionmentioning

confidence: 99%

Laser surgery of port wine stains using local vaccum pressure: Changes in calculated energy deposition (Part II)

et al. 2007

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Background and Objectives: Application of local vacuum pressure to human skin during laser irradiation results in less absorption in the epidermis and more light delivered to targeted vessels with an increased blood volume. The objective of the present numerical study is to assess the effect of applying local vacuum pressure on the temperatures of the epidermis and small vessels during port wine stain (PWS) laser treatment. Study Design/ Materials and Methods: Mathematical models of light deposition and heat diffusion are used to compute absorbed energy and temperature distributions of skin and blood vessels with different diameters (10-60 mm) at various depths (200-800 mm) exposed to laser irradiation under atmospheric and vacuum pressures. Results: Under 50 kPa (15 in Hg) vacuum pressure, peak temperatures at the inner walls of small diameter vessels (10-30 mm) located 200-300 mm below the skin surface are %108C higher than those under atmospheric pressure, and peak temperatures in the epidermis of patients with skin phototype II are %58C lower. In patients with darker skin phototype (IV), the peak temperature at the inner wall of a 10 mm diameter vessel located 200 mm below the skin surface is %58C higher than that under atmospheric pressure, and the peak temperature in the epidermis is %108C lower. Conclusions: Additional energy deposition in a larger blood volume permits higher temperatures to be achieved at vessel walls in response to laser irradiation. While more energy is deposited in every vessel, temperature gains in small diameter vessels (10-30 mm) are greater, increasing the likelihood of irreversible thermal damage to such vessels. In addition, temperatures in the epidermis decrease because less energy is absorbed therein due to reduced epidermal thickness and concentration of melanin per unit area.

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The depth measuring videomicroscope (DMV): A non‐invasive tool for the assessment of capillary vascular malformations

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.

Cited by 22 publications

References 31 publications

A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations

A direct comparison of pulsed dye, alexandrite, KTP and Nd:YAG lasers and IPL in patients with previously treated capillary malformations

Laser surgery of port wine stains using local vacuum pressure: Changes in skin morphology and optical properties (Part I)

Laser surgery of port wine stains using local vaccum pressure: Changes in calculated energy deposition (Part II)

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