- THIS MATERIAL IS PUBLISHED AND PROTECTED BY U.S. 
COPYRIGHT LAW - REPRODUCTION PROHIBITED UNLESS 
FOR PERSONAL USE, EXCEPTING AUTHOR PERMISSION - 

  
Peter F. Kelly, D.P.M., F.A.C.F.A.S.  
  
Diplomate, American Board of Podiatric Surgery  
Fellow, American College of Foot and Ankle Surgeons

  
CHAPTER 37  
LASER APPLICATIONS IN PODIATRIC SURGERY  
  
 
LASER APPLICATIONS IN PODIATRIC SURGERY  
  
 	Applications of lasers to medicine and surgery have increased  
exponentially over the past decade.  This  technology has become  
established in the medical community and has become the standard of  
care for many procedures.  Lasers have justified their utilization by the  
improved clinical outcome in the delivery of comparably more traumatic  
and invasive procedures.  Some procedures are not possible without the  
precision or uniqueness of this modality.    
 
	There are a great variety of laser types and delivery systems,  
each having indications unique to the desired tissue response.   
Fundamental to the surgeon in selecting the wavelength, power and  
control to produce the intended effect, with safe handling of the  
instrument, is a knowledge of laser physics for this tissue interaction.  


CLINICAL LASER APPLICATIONS IN PODIATRIC SURGERY  
  
STANDARD OF CARE  
 
1. OPERATIVE REPORT - Include laser type power density  
	calculation.   
i.e.:  "Procedure:  Austin Bunionectomy, left foot (Soft tissue with CO2  
	laser):  With the CO2 laser set at 33,000 W/cm2 power density, a linear  
	incision was ..."  
   
2. CONSENT FORM - Include the laser type or wavelength used and  
	the intended application of the laser if there is conventional  
	instrumentation used.  
i.e.: "(Usual description of surgery), soft tissue with CO2 laser"  
  
3. ETHICS IN ADVERTISING - Differentiate the application of the  
	laser  
i.e.:  "Laser assisted" bunionectomy, or "Laser for soft tissue"  
	Advertise straightforward what laser procedures (warts, nails) are done if  
	also advertising conventional procedures (bunionectomy) that are not  
	performed with laser assistance.  
  
Public misconceptions:  No incision, laser cuts bone.  
	You will never lose a patient because of an honest disclosure of a  
	procedure.  
 
 
  
OTHER SURGICAL LASERS  
  
Other medical lasers available with properties, delivery systems unique  
	to each  
Podiatry is already using these, but be familiar with basic lasers first  
  
Ho:YAG LASER   
 
	1. A near-contact laser being used for resecting calcaneal spurs  
	2. Good for endoscopic and arthroscopic work  
	3. Transmits through water  
	4. Also indicated for cartilage ablative procedures for joint  
		restoration  
  
COPPER VAPOR LASER  
 
	1. Known largely for treating port wine stain  
		and congenital cutaneous vascular pathologies  
	2. Two wavelengths - yellow and green  
	3. Yellow for superficial vascular  
	4. Green for deeper vascular  
	5. Dermatological surgery  
	6. Very inefficient, large laser, long warm-up period  
  
Q-SWITCHED LASERS  including PULSED-DYE
 
	1. Used to be used in ophthalmic procedures  
	2. Q-switched Ruby and Q-switched Nd:YAG for tattoo  
		removal  
	3. No anesthesia necessary  
		Multiple treatments necessary  
	5. Little scarring results, mild hypopigmentation  
	6. Tunable-dye is variable within the visible range
	  	Multiple treatments necessary  

EXCIMER LASER  
 
	1. UV laser, 0.2 mm absorption  
	2. Ionizing radiation  
	3. Cardiac catheterization, osteotomy, corneal sculpting  
	4. High frequency, short wavelength means high precision  
  
Er:YAG LASER  
 
	1. Mid infrared, 0.1 mm absorption  
	2. Bone surgery  
	3. Difficulty in fiberoptic delivery - fragile and toxic