Laser treatment of various warts Ordinary CO2 laser is currently the main method for treating genital warts. The new super-pulse CO2 laser and erbium laser can vaporize and remove wart tissue easily and quickly, with minimal thermal damage to surrounding tissues, fast postoperative recovery, and less scarring.
1. Routine skin and hand disinfection, and local infiltration anesthesia under the skin lesion.
2. Selection of laser and laser parameters
(1) UltraPulse super pulse CO2 laser: CPG handpiece for gasification, energy 500 mJ, power 25-50 W; handpiece for excision with spot 0.2mm, energy 300mJ, power 12-15 W.
(2) SilkTouch laser: You can use a 125mm handpiece, a spot diameter of 0.6-3mm, and a power of 5-15 W for vaporization. You can also use continuous wave settings for cutting.
(3) Er:YAG (erbium laser): It can be used for vaporization with a 3mm spot, frequency 1-10 Hz, power 5-15J/cm2. Erbium laser causes less damage to surrounding tissues than C02 laser. , the vaporization is more precise, but the erbium laser requires more pulses than the CO2 laser for the same treatment depth. If the wart is larger and deeper, it is better to use the CO2 laser for treatment. Erbium laser is more suitable for treating flat warts.
3. Laser treatment method (taking UhraPulse as an example)
Select the appropriate hand and light spot according to the size of the skin lesion to vaporize the lesion. The vaporization range should be 1-5mm outside the skin lesion.
(1) Laser treatment of common warts: You can use a 0.2mm handpiece to cut from the base of the wart along the tangent direction of the skin, and then use a CPG handpiece with a diameter of 2-3mm to vaporize the base until the normal organize. It should be noted that periungual warts often invade the underside and around the nail plate. Warts located above the nail should be vaporized with CO2 laser to avoid tearing the nail; warts located under the nail should continue to be vaporized and cleaned, but care should be taken to retain the residue as much as possible. nails.
(2) Laser treatment of flat warts: Hands with a diameter of 1 mm can be used to vaporize the skin lesions, and scarring caused by excessive vaporization should be avoided.
(3) Laser treatment of plantar warts: Use a CPG hand with a diameter of 2-3mm to vaporize the warts until normal tissue is exposed.
(4) Laser treatment of genital warts: Before vaporization, you can use a 0.2mm handpiece to remove the lesion from the base of the lesion in the tangent direction of the skin, and then use a CPG handpiece with a diameter of 2-3mm Vaporize the base (skin lesions with inconspicuous hyperplasia and bulges do not need to be cut, and can be directly vaporized with CPG hand) until the wart tissue disappears and the base bleeds in spots. Finally, raise the hand to solidify the bleeding points. . If there are large blood vessels that are difficult to coagulate with laser, they can be sutured to stop the bleeding. For giant genital warts, treatment can be done in stages.
After the operation, antibiotic ointment is applied to the wound surface. Smaller wounds are exposed, and larger wounds are wrapped with sterile gauze.
4． Smoke handling and protection during laser treatment When a wart or some other tissue is vaporized by a laser, a smoke composed of vapor and fine particles is produced. Papillomavirus DNA and viral particles can be detected in its smoke. Whether these particles are infectious cannot be answered with certainty. To date, natural transmission of human papillomavirus during laser surgery has not been confirmed. However, the risk of contagious warts does exist, so a well-functioning smoking device and a thicker mask should be used during laser surgery to minimize the risk.
Excerpted from: Air Force General Hospital article