Surgical cleansing of varicose ulcers of the leg using a CO2 laser with rotating mirror scanner.

OBJECTIVE: Our purpose was to evaluate the effectiveness of cleansing by CO2 laser with a rotating mirror scanner in accelerating ulcer granulation and reducing sensitization, bleeding, and the need for painful medications. SUMMARY BACKGROUND DATA: Cleansing, the first step in treating phlebostatic ulcers, may be performed with a defocussed CO2 laser, but laser-to-target distance, technique, and duration of the procedure may vary.
METHODS: We studied 20 patients, ages 38-85, with "common" phlebostatic ulcers showing a tendency not to granulate. The patients were divided into two groups by sex (7 females and 3 males) and by size of ulcer. The first group was treated using the CO2 laser and rotating mirror scanner; the second was treated surgically with scissors and tweezers. In both groups debridement was followed by mobile and fixed elastocompressing bandage, mobilization, and phlebotonics. Six patients in the first group and four in the second subsequently underwent short stripping to correct the incompetent saphenous circulation.
RESULTS: Ulcer cleansing was achieved in all 20 cases. In the laser group, the treatment was well tolerated by 9 patients and granulation was achieved in 10 days on average; in the second group, cleansing was very painful in 5 cases and granulation was achieved in 25 days on average. Both groups had good cicatrization at 3 months after elastocompression, zinc dioxide medication, mobilization, and phlebotonics. The 6-month follow-up revealed only one recurrence--a small ulcer at a different location--in the first group and no cases of recurrence in the second.
CONCLUSIONS: Cleansing by CO2 laser and rotating mirror scanner allows the acceleration of ulcer granulation and reduces sensitization, bleeding, and the need for painful and costly medications.