What is the primary function of CO2 laser systems for HS treatment? Precision Ablation for Chronic Lesions

Professional-grade CO2 laser systems serve as precision surgical tools designed for the ablative excision and vaporization of chronic Hidradenitis Suppurativa (HS) tissues. Unlike standard scalpels, these systems utilize high-energy thermal effects to physically remove damaged tissue—specifically nodules and deep sinus tracts—while simultaneously cauterizing the area to prevent bleeding and significantly reduce postoperative recurrence.

Core Takeaway The CO2 laser is not merely a cutting tool; it is a "bloodless" surgical instrument that allows for superior visualization. By vaporizing tissue and sealing blood vessels instantly, it enables surgeons to precisely trace and eliminate complex sinus tracts that traditional surgery often misses, leading to lower recurrence rates.

The Mechanics of Clinical Application

Ablative Excision and Vaporization

The primary mechanism of the CO2 laser is the delivery of high-energy thermal waves to the affected skin. This energy effectively vaporizes pathological tissues, including stubborn nodules, masses, and fistulas.

Rather than simply cutting the skin, the laser performs an "ablative" function. It removes the physical structure of the lesion layer by layer, allowing for the total elimination of the diseased tissue source.

The "Deroofing" Technique

A critical application of this technology is "deroofing." In this specific technique, the laser vaporizes the "roof" of sinus tracts (tunnels under the skin), fully exposing the base of the tract.

This process removes the damaged epidermal appendages and inflammatory granulation tissue inside the tunnel. Because it preserves the healthy tissue surrounding the lesion, this method is often less invasive than wide excision and frequently requires only local anesthesia.

Hemostasis and Visual Precision

One of the distinct advantages of CO2 lasers over "cold steel" (scalpel) surgery is the ability to seal small blood and lymphatic vessels while cutting.

This creates a nearly bloodless surgical field. Without blood obscuring the view, the surgeon can clearly identify the boundaries of the disease, ensuring that deep sinus tracts are fully closed or removed.

Understanding the Trade-offs

Healing by Secondary Intention

It is important to understand that CO2 laser wounds are typically left open to heal "by secondary intention" rather than being stitched shut.

While this requires wound care post-surgery, it prevents the trapping of bacteria that can occur with sutures. This approach generally leads to better cosmetic outcomes and minimizes the risk of skin contracture (tightening) that limits movement.

CO2 vs. Laser Hair Removal

A common point of confusion is the difference between CO2 lasers and hair removal lasers (like Nd:YAG or Diode).

CO2 Lasers are ablative; they vaporize existing, chronic tissue and are used for surgical management. Hair Removal Lasers utilize selective photothermolysis to destroy hair follicles to prevent future flares. They do not remove existing sinus tracts or nodules.

Making the Right Choice for Your Goal

Depending on the stage and severity of the Hidradenitis Suppurativa, the laser application differs significantly.

• If your primary focus is treating chronic, existing lesions: The CO2 laser is the correct tool for performing deroofing or excision to physically remove sinus tracts and nodules.
• If your primary focus is preventing new outbreaks: Long-pulse lasers (like Nd:YAG) are better suited to destroy hair follicles and reduce mechanical irritation in early-stage disease (Hurley Stage II).

The CO2 laser represents a shift from simple cutting to precise, thermal elimination of the disease architecture.

Summary Table:

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References

1. Afsáneh Alavi, Christos C. Zouboulis. Proceedings of the Joint <scp>CHSF</scp>/<scp>HSF</scp>/<scp>EHSF</scp> pre‐<scp>WCD</scp> Hidradenitis Suppurativa Symposium. DOI: 10.1111/exd.12903

This article is also based on technical information from Belislaser Knowledge Base .

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