Combination Erbium and CO2 laser

Skin Resurfacing – Laser Surgery Treatment & Management: Surgical Therapy, Preoperative Details, Intraoperative Details

The technique is similar to that of carbon dioxide, except pulses are overlapped by 10%. From a tissue interaction perspective, avoiding overlap with the Er:YAG is not as critical as with the pulsed carbon dioxide laser because virtually no tissue debris is produced. However, repeatedly firing at the same spot produces a hole in the skin. Also, wiping between passes or mechanically abrading with the sponge is unnecessary.

Because of the lack of coagulation necrosis produced by Er:YAG, the characteristic skin depth-color changes of the pulsed carbon dioxide laser are not observed. A useful depth indicator is pinpoint bleeding that occurs when in the papillary dermis. If this continues to ooze, hold a lidocaine-epinephrine soaked sponge over the region for 15-30 seconds. A smoke evacuator is mandatory because this high-powered laser turns the superficial skin layer into airborne particulate matter. In addition to eye protection for 2940 nm, physicians and assistants should wear laser masks that filter 0.1-µm particles. The author rarely performs more than 3 passes on the eyelids with the Er:YAG.

Combined carbon dioxide and Er:YAG laser
The procedure is performed identically to that of the Er:YAG. Fewer passes are required because of the presence of subablative carbon dioxide energy. Oozing rarely occurs because of these heating properties.

Another interesting laser finding for Biofilms

The technique was performed using a Q-switched, ND:YAG rhythmically laser functioning at a “rep rate of 10 Hz with 1500 mJ pulses centered at 1064 nm. The laser pulses were used to create shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 50 MPa” was able to reduce 55% living microorganisms.134 The laser technique offers another way of disrupting biofilms and is useful in the management of infected wounds, where standard treatment modalities such as topical antimicrobials or the removal of dead, damaged, or infected tissue are unsuccessful or injurious. One study found that just 4–10 seconds of the laser therapy was able to disperse 97.9% of P. aeruginosa from biofilms on nitinol stents to single-celled planktonic microorganisms that can be more easily treated with antibiotics.135 Another found that laser-generated shockwaves therapy quickly disrupts the biofilms in infected wounds to eliminate the microorganisms and intensify the effectiveness of topical antimicrobials in the residual biofilm. Such interventions will promote patients’ quality of life by reducing healing times and morbidity, and save health care costs.136

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134941/

Abu Bakar, Muhamad, et al. “Chronic Tonsillitis and Biofilms: A Brief Overview of Treatment Modalities.” Journal of Inflammation Research, vol. 11, Sept. 2018, pp. 329–37. PubMed Central, doi:10.2147/JIR.S162486.

Something else PBM low fluence

Study of the proliferation of human adipose-derived stem cells following PBM showed a peak dose response for 810 nm at a fluence of 3 J/cm², whereas, the peak dose response for 980 nm was observed at fluences of 0.03 or 0.3 J/cm² [43]. However, a study in a transcranial mouse TBI model showed superior beneficial effects of 810 nm compared with 980 nm wavelengths at the same fluence (36 J/cm²) [97]. It seems that, due to different dose-response, PBM using much lower doses of 980 nm wavelengths could be required, compared to the doses needed of 810 nm light.

Salehpour, Farzad, et al. “Brain Photobiomodulation Therapy: A Narrative Review.” Molecular Neurobiology, vol. 55, no. 8, Aug. 2018, pp. 6601–36. PubMed Central, doi:10.1007/s12035-017-0852-4