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. 2015 Aug;47(6):469-75.
doi: 10.1002/lsm.22369. Epub 2015 Jun 3.

Intraoperative, real-time monitoring of blood flow dynamics associated with laser surgery of port wine stain birthmarks

Bruce Yang  1   2 , Owen Yang  1   2 , John Guzman  1   2 , Paul Nguyen  1   2 , Christian Crouzet, Kathryn E Osann  3 , Kristen M Kelly  1   4 , J Stuart Nelson  1   2   3   4   5 , Bernard Choi  1   2   5   6
Affiliations

Intraoperative, real-time monitoring of blood flow dynamics associated with laser surgery of port wine stain birthmarks

Bruce Yang et al. Lasers Surg Med. 2015 Aug.

Abstract

Background and objective: Port-wine stain (PWS) birthmarks affect ∼22 million people worldwide. After several treatment sessions, complete disappearance of the PWS occurs in only ∼10% of treated patients. There is a need to develop a new strategy to improve the efficacy of each treatment session and the overall treatment outcome. The study objective was to determine how intraoperative measurements of blood flow correlate with treatment response assessed several weeks post treatment.

Study design/materials and methods: We employed Laser Speckle Imaging (LSI) to measure intraoperative blood-flow dynamics. We collected data from 24 subjects undergoing laser therapy for facial PWS birthmarks. Photographs were taken before treatment and at a follow-up visit, and analyzed by two expert observers.

Results: Intraoperative LSI enables real-time monitoring of blood-flow dynamics in response to laser treatment and can inform clinicians on the need for focused re-treatment. The degree of PWS blanching achieved is positively correlated with the log-transformed acute blood-flow reduction (P = 0.022).

Conclusion: LSI is a simple, intraoperative monitoring tool during laser therapy of PWS birthmarks. LSI provides a single value for blood flow that correlates well with the degree of blanching achieved with laser therapy.

Keywords: blood perfusion; laser Doppler; optical imaging; pulsed dye laser; speckle contrast.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Fig. 1
Fig. 1
Intraoperative LSI enables real-time monitoring of photocoagulation in response to laser therapy. (A,C) Webcam and (B,D) SFI images extracted from the real-time video feed, are shown (A, B) before and (C,D) immediately after treatment of a PWS birthmark located on the left temple of an adult male subject. With a single pass of 585 nm pulsed-dye laser irradiation (7.5 J/cm2, 10 mm spot size, 0.45 ms pulse duration), a 37% reduction in SFI was observed.
Fig. 2
Fig. 2
Intraoperative LSI enables real-time monitoring of photocoagulation of superficial vasculature achieved with different clinical laser systems. SFI images extracted from the real-time video feed, are shown (A) before laser treatment, (B) after a single pass of an alexandrite laser (60J/ cm2, 10 mm spot size, 3 ms pulse duration), and (C) after two passes of a pulsed-dye laser (Pass 1: 10J/ cm2, 10 mm spot size, 3 ms pulse duration; Pass 2: 6.5J/ cm2, 12 mm spot size, 0.45 ms pulse duration) treatment of a PWS birthmark located on the right cheek of a 40-year old female subject.
Fig. 3
Fig. 3
Intraoperative LSI data may inform clinicians with the need for immediate re-treatment of PWS skin. (A,C,E) Webcam and (B,D,F) SFI images extracted from the real-time video feed, are shown (A,B) before treatment, (C,D) after two consecutive passes (Pass 1: 7.0 J/cm2, 10 mm spot size, 3 ms pulse duration; Pass 2: 8.5 J/cm2, 10 mm spot size, 1.5 ms pulse duration), and (E,F) after a third pass (7J/ cm2, 10 mm spot size, 0.45 ms pulse duration) of a PWS birthmark located on the right temple and cheek of a 3-year old female subject.
Fig. 4
Fig. 4
The degree of blanching of the PWS birthmarks increases with a decrease in SFI (n =24). We assessed degree of blanching with qualitative scoring of color photographs taken prior to laser treatment and at a follow-up visit by each subject. We quantified the decrease in SFI from the LSI data collected during laser treatment. Four of the 24 subjects (data points within red oval) experienced minimal blanching of their PWS birthmarks despite a relatively large decrease in SFI.
See this image and copyright information in PMC

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