Healing of incisions in the tongue: a comparison of results with milliwatt carbon dioxide laser tissue welding versus suture repair

A preliminary study of healing of diode laser versus scalpel incisions in rat oral tissue: a comparison of clinical, histological, and immunohistochemical results

OBJECTIVE

The aim of this preliminary study was to compare wound healing of rat oral tissues after surgical procedure with diode laser or scalpel. Healing was evaluated histologically, immunohistochemically, and by measurement of 2 nitric oxide synthase isoforms (eNOS and iNOS) as intracellular messenger molecules with important immune functions. The instruments were also evaluated for performance and ease of use.

STUDY DESIGN

Twenty-four standardized incisions were performed in the hard palate of 12 male Wistar rats. Each rat received 2 incisions on the opposite sides of the palate by using a steel scalpel (control group) and a diode laser (808 nm) at a power output of 4 W and 6 W (test group). Histological and immunohistochemical analyses were performed on tissue samples after 7 and 14 days. The expression of eNOS and iNOS was confirmed by RT-PCR (reverse transcriptase-polymerase chain reaction) and Western blot analysis.

RESULTS

Scalpel repair was found to be equivalent to or better than laser repair at the intervals measured. Histological analysis showed that incision wound repair after laser surgical procedure was related to parameters and beam characteristics. Diode laser at a power output of 6 W showed the worst results of tissue repair, especially after 7 days. On the contrary, the extent of epithelial damage lateral to the wound edge and the extent of collagen denaturation were near equal with scalpel incision and laser irradiation at 4 W after 14 days. Biochemical analysis of RT-PCR and Western blots also confirmed histological results with a greater concentration of eNOS and iNOS after 7 days of laser surgical procedure.

CONCLUSIONS

Clinical and histological findings change over time for different treatments. Diode laser tends to produce more pronounced changes than conventional scalpel surgical procedure (due to tissue thermal damage), with corresponding greater inflammatory reaction and delay in tissue organization only at the initial stage. Thus, long-term histology is critical for predicting treatment results. The clinical use of low-level diode laser for tissue welding of oral mucosa should be investigated further, since it appears to be a good alternative to scalpel incision and suture repair.

Quantitative evaluation of intact peripheral nerve structures after utilization of CO2 laser, electrocautery, and scalpel

OBJECTIVE

This study aimed to evaluate quantitatively the integrity of nerve structures near CO2 laser incisions.

BACKGROUND DATA

There are some hypotheses that try to explain the analgesia reported after CO2 laser surgery. One of them is based upon the observation of the destruction of nerve endings after use of this technique.

METHODS

A comparative study was carried out using 25 animals (Rattus norvegicus) divided into five groups of 5 animals each. Standard incisions were carried on the dorsum of the tongue of each animal using the cautery (group 2), scalpel (group 3), CW CO2 laser (group 4), and SPS CO2 (group 5); group I served as control. The animals were killed immediately after the experiment, and specimens were taken and routinely processed to wax. Three-micrometer sections were cut and stained using S-100 protein antibody. The stained sections were analyzed under light microscopy using a calibrated graticule, and the number of intact nerves was counted in five standard areas around the incision.

RESULTS

The results of this study showed that there were no statistically significant differences in the numbers of intact peripheral nerve structures in both laser groups and other groups. No statistically significant difference was found between nonoperated and scalpel groups. The number of intact peripheral structures in cautery wounds was significantly smaller than in non-operated and scalpel wounds.

CONCLUSIONS

Therefore, it is unlikely that immediate destruction of peripheral nerve structures is the cause of post-operative analgesia following CO2 laser surgery.

Effect of CO(2)-Milliwatt laser on peripheral nerves: part II. A histological and functional study

In order to further explore the role of laser for microneural repair, the early and late effects of CO(2) laser irradiation on intact rat sciatic nerves were investigated. A total of 48 rat sciatic nerves were exposed to 100-mW laser power with a pulse duration of 1.0 s and a spot size of 320 microm. In one-half of the nerves, albumin solder was applied to the nerve followed by laser irradiation. The results were evaluated up to 94 days after surgery with functional toe-spreading test, and light and transmission electron microscopy. Irradiation of the nerve resulted in almost no deficit in the motor function. A subperineurial degeneration of myelinated and unmyelinated axons is observed in the first 2 weeks after laser irradiation, while the central part of the nerve remains undamaged. The degeneration is followed by axonal regeneration with subsequent maturation of nerve fibres in time. No excessive intraneural or extraneural scarring was seen. In the soldered nerves, the solder elicits an inflammatory reaction upon the epineurium in the first week after irradiation. By week 1, the solder is completely absorbed. After 2 weeks, the inflammatory reaction ceases and by week 4, no residual reaction is seen. At 12 weeks, only minimally disarranged epineurium is seen with otherwise normal neural architecture. In conclusion, CO(2) laser irradiation at 100 mW with pulses of 1.0 s has no long term negative effects on nerve function and morphology. Therefore, these laser settings can be safely applied for laser-assisted nerve repair.

Electron microscopy comparison of CO2 laser flash scanning and pulse technology one year after skin resurfacing

BACKGROUND

The recent adaptation of laser technology in plastic and dermatologic surgery has provided a means to reduce efficiently the irregularities of the surface of the skin. Previous studies have analyzed the short- and medium-term clinical and histologic results of two laser systems: the Sharplan 40C SilkTouch and the 5000C Coherent Ultrapulse with Computer Pattern Generator (CPG). This paper contains the long-term ultrastructural findings observed with the aid of transmission electron microscopy (TEM).

MATERIALS AND METHODS

Twenty skin biopsy specimens were taken from ten Caucasion patients, between 54 and 72 years of age, who had undergone facial skin resurfacing with a CO2 laser 1 year previously. The treated areas of the face were divided into two equal parts. One half of the face was treated with the Sharplan SilkTouch laser and the other half with the Coherent Ultrapulse laser. Using TEM, the cell composition of the epidermis was studied ultrastructurally, as were the dermal-epidermal junction (DEJ) and the different fibers and cells in the superficial and middle dermis.

RESULTS

On the side treated by the Sharplan laser, little melanin was observed, the DEJ was thicker, and there were abundant collagen fibers well compacted in the dermis. Also present was abundant elastin fiber with scarce interstitial spaces. On the side treated by the Coherent, the melanin was abundant and the DEJ was well structured. There were fibroblasts with lax chromatin in the dermis and collagen fibers in the papillary dermis oriented in a vertical and horizontal manner in relation to the epidermis. There was little elastin. The interstitial spaces were abundant.

CONCLUSIONS

The Sharplan laser system seems to provoke a significantly more intense tissue response, with abundant dermal collagen and elastic fibers. This indicates that the Sharplan 40C SilkTouch might produce longer lasting clinical effects.

Effects of scalpel, electrocautery, and CO2 and KTP lasers on wound healing in rat tongues

OBJECTIVE

Evaluate wound healing of incisions created by the scalpel, electrocautery, CO2 laser, and potassium titanyl phosphate (KTP) laser in the upper aerodigestive tract in an animal model.

STUDY DESIGN

Prospective randomized study in an animal model.

METHODS

Postoperative oral intake, histologic depth of injury, and tensile mechanical strength were measured in rat tongues after creating incisions using a scalpel, electrocautery, CO2 laser, and KTP laser. An unpaired, two-tailed Student's t-test was used to compare results between the experimental groups.

RESULTS

Oral intake, indirectly assessed by postoperative weight loss, by the third postoperative day was significantly decreased in the electrocautery (P = 0.004), CO2 laser (P = 0.001), and KTP laser (P = 0.0001) groups as compared with the scalpel group. The depth of the wound healing, as assessed by histologic examination, was successively greater for the scalpel (75 +/- 13 microm), electrocautery (110 +/- 10 microm), CO2 laser (145 +/- 10 microm), and KTP laser (195 +/- 23 microm) groups. However, this difference was only statistically significant for the CO2 laser (P = 0.006) and KTP laser (P = 0.01) groups relative to the scalpel group. Wounds created by the KTP laser had the lowest strength (76.5 +/- 6.9 kPa) as compared with the CO2 laser (156 +/- 28.4 kPa), electrocautery (153 +/- 15.7 kPa), and scalpel groups (249 +/- 61.8 kPa). This difference was only statistically significant for the KTP laser group (P = 0.02) when compared with the scalpel group.

CONCLUSIONS

Wounds created in the upper aerodigestive tract of rats by scalpels result in the least postoperative weight loss, tissue destruction, and decrease in tensile strength, whereas wounds created by the KTP laser demonstrated a significantly greater postoperative weight loss, depth of wounding, and decrease in tensile strength.