The study utilized a specific high-energy protocol centered on a Q-switched Nd:YAG laser system. The treatment involved a 1,064 nm wavelength delivered through a 2 mm spot diameter at a frequency of 10 Hz, with energy levels set between 10 and 12 J.
Core Takeaway The procedure’s effectiveness relied on a combination of specific laser parameters and physical tissue manipulation. By manually stretching the skin to restrict blood flow during the application of the 1,064 nm Q-switched Nd:YAG laser, practitioners were able to inhibit bleeding while targeting the melanocytic nevi.
The Clinical Protocol Step-by-Step
Pre-Operative Preparation
Success began with proper patient preparation to ensure comfort and safety. A topical anesthetic cream was applied to the treatment area 40 minutes prior to the procedure.
Following anesthesia, the area was thoroughly cleaned using normal saline. Both the patient and the operator utilized protective eye shields to prevent ocular damage from the laser.
Laser System Configuration
The study employed a Q-switched Nd:YAG laser configured specifically for deep pigment targeting. The wavelength was set to 1,064 nm, a standard for penetrating deeper into the dermis to reach melanocytes.
The delivery parameters included a 2 mm spot diameter and a frequency of 10 Hz. The energy output was maintained between 10 and 12 J, providing sufficient power to disrupt pigment without excessive thermal damage.
Intra-Operative Technique
A critical manual technique was employed during the laser firing. The skin surrounding the nevus was pulled taut by the operator.
This physical stretching served a physiological purpose: it temporarily blocked blood flow to the area. This induced ischemia helped inhibit bleeding during the laser pulses, allowing for a cleaner procedural field.
Understanding Operational Trade-offs
Managing Hemorrhage
Despite the preventative measure of stretching the skin, bleeding remains a potential side effect. The protocol required immediate management of any breakthrough bleeding using sterilized tissue paper.
Operators applied vertical tension to stanch the flow. This indicates that while the laser is minimally invasive, hemostasis requires active, hands-on management.
Session Frequency vs. Clearance
While the specific procedure described is for a single session, total clearance is not always immediate. Approximately 70% of nevi were removed in the first session described above.
However, the remaining 30% required follow-up. Complete treatment for these persistent cases necessitated a total of three sessions to achieve the desired aesthetic result.
Applying These Findings to Clinical Practice
To replicate the results observed in this study, consider the following approach based on your clinical goals:
- If your primary focus is procedural replication: Adhere strictly to the 10–12 J energy setting and the manual skin-stretching technique to minimize intra-operative bleeding.
- If your primary focus is patient counseling: Advise patients that while many achieve clearance in one visit, difficult cases may require up to three sessions for complete removal.
This protocol demonstrates that precise laser parameters, combined with physical tissue manipulation, can offer an effective alternative to surgical excision for congenital nevi.
Summary Table:
| Parameter | Specification |
|---|---|
| Laser Type | Q-switched Nd:YAG |
| Wavelength | 1,064 nm |
| Energy Level | 10 - 12 J |
| Spot Diameter | 2 mm |
| Frequency | 10 Hz |
| Primary Technique | Manual skin stretching (Ischemia) |
| Success Rate | ~70% clearance in one session |
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