The defocused mode is primarily selected to reduce energy density per unit area, allowing for safer, superficial vaporization of the skin. By utilizing a larger spot size (such as 2.0mm), the laser spreads its power over a wider surface rather than concentrating it into a deep cutting beam. This technique effectively ablates the base of vesicles while significantly minimizing the risk of deep tissue burns and subsequent scarring.
The core advantage of the defocused mode is controlled gentleness. It allows the operator to vaporize surface lesions and seal lymphatic vessels without penetrating deep enough to cause permanent thermal damage to healthy underlying tissue.
The Mechanics of Defocused Energy
Increasing the Spot Size
In a defocused setting, the laser beam is adjusted to cover a wider diameter, typically around 2.0mm.
This contrasts with a focused "cutting" mode, which uses a pinpoint beam to slice through tissue. The larger spot size is essential for treating broader areas of the skin surface quickly and evenly.
Lowering Energy Density
By spreading the same amount of power over a larger spot, the intensity of the heat is diluted.
This prevents the laser from drilling deep holes into the dermis. Instead, the energy remains concentrated on the superficial layers, which is ideal for removing the thin-walled vesicles characteristic of Lymphangioma Circumscriptum.
Clinical Benefits for Lymphangioma Circumscriptum
Gentle Ablation of the Vesicle Base
The primary goal is to remove the tops of the vesicles and vaporize the wound base.
The defocused mode "processes" this base gently. It effectively clears the lesion tissue without delivering the intense, concentrated heat that leads to necrosis (tissue death) in deeper layers.
Prevention of Scar Formation
Scarring is a major concern when treating benign lymphatic malformations.
High-focus beams risk causing deep thermal burns, which almost invariably heal with scars. The defocused mode creates a shallow wound that heals more cosmetically, reducing the likelihood of long-term postoperative disfigurement.
Hemostasis and Vessel Sealing
While vaporizing tissue, the CO2 laser simultaneously generates heat that cauterizes the wound.
This thermal effect seals deep lymphatic vessels and superficial blood vessels. This sealing action is critical for preventing immediate post-procedure leakage of lymph fluid and blood.
Understanding the Trade-offs
Palliative vs. Curative
It is vital to understand that laser ablation in this mode is generally palliative, not curative.
While it effectively flattens lesions and reduces symptoms, the recurrence rate is higher than with complete surgical excision. The laser removes the surface manifestation, but deeper lymphatic cisterns may remain.
Depth Limitation
The safety provided by the defocused mode limits how deep the treatment goes.
For very thick, fibrotic plaques, the operator may need to adjust power settings (e.g., to 5–10 Watts) to penetrate effectively. However, increasing depth to chase the lesion always increases the risk of complications like erythema or hypopigmentation.
Making the Right Choice for Your Goal
When determining the treatment strategy for Lymphangioma Circumscriptum, consider the specific patient outcomes desired:
- If your primary focus is cosmetic safety: Prioritize the defocused mode to maximize superficial clearing while protecting the dermis from deep burns and scarring.
- If your primary focus is treating complex anatomy: Utilize the laser as a minimally invasive alternative to surgery, accepting a higher recurrence rate in exchange for better compliance and reduced trauma in difficult areas.
- If your primary focus is debulking thickened plaques: Carefully increase power settings (5-10 Watts) while monitoring depth to vaporize fibrotic tissue without crossing the threshold into deep thermal injury.
The defocused CO2 laser offers the optimal balance between effective symptom management and the preservation of skin integrity.
Summary Table:
| Feature | Focused Mode (Cutting) | Defocused Mode (Ablation) |
|---|---|---|
| Spot Size | Pinpoint (Small) | Wider (e.g., 2.0mm) |
| Energy Density | High (Concentrated) | Low (Diluted) |
| Primary Effect | Deep Incision / Cutting | Superficial Vaporization |
| Clinical Use | Excision of tissue | Treating surface vesicles |
| Scarring Risk | Higher risk of deep burns | Minimal risk; cosmetic healing |
| Lymphatic Sealing | Sharp cut | Effective vessel cauterization |
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References
- Santos MK. Lymphangioma Circumscriptum with Features of both Classic and Localized Forms Treated with Carbon Dioxide Laser. DOI: 10.23880/cdoaj-16000183
This article is also based on technical information from Belislaser Knowledge Base .
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