Laser Surgery

I am very proud to be one of only two veterinary dermatologists in England and Wales to own the Vetscalpel C02 laser. This machine which has been updated over the years, now offers even more power which results in fast and safe excision or ablation of a wide variety of skin lesions where other modalities are either extremely difficult and blood or actually impossible. A CO2 laser allows effective removal of tissue with minimal thermal damage to the surrounding tissue, either as an excision or an ablation. Haemostasis is excellent and the nerve endings are sealed which results in far less post-operative pain and swelling compared to conventional surgery.

 

 

 

 

 

 

 

 

The main reason it was purchased  was to :

1. Treat a debilitating condition, often seen an allergic dogs or on dogs with poor conformation, called Chronic Pododermatitis and Interdigital Furunculosis (CPIF).  Although some mild cases of this condition can be treated with steroids, cyclosporine, and Epsom salts soaks, many cases are too advanced to be treated medically. In this condition the inflammation between the toes and/or  abnormal conformation (seen particularly in English Bulldogs and similar breeds) results in the haired skin swelling up and becoming level with the pads, becoming ” false pads”.  Constant weight-bearing on the interdigital haired skin results in clogging up of the openings of the hair follicles resulting in trapped sebaceous secretions,  infection and eventual rupture of the hair follicle internally, releasing keratin and sebum into the subdermal tissue which then causes a foreign body reaction which often shows as the development of interdigital furuncles (incorrectly called interdigital cysts). In the past, if medical therapy was ineffective, the only solution many years ago was an operation called a fusion podoplasty, where the interdigital skin was removed by sharp surgery and the toes sutured to each other. The surgery had a very high failure rate and the result was not perfect the toes being sutured together so the foot was like a mitten rather than a glove. Now, the treatment of choice now for these more severe cases is what is a CO2 laser podoplasty. I have treated several cases where the false pat tissue was very localized using my diode laser, but the diode laser produces a lot more thermal collateral damage and is not suitable for treating extensive cases    where the whole foot is affected. Once the tissue is removed with the laser wound is left to heal by what is called secondary intention, usually bandaging the foot for a week or so and then leaving the wound        open to heal fully within 3 to 4 weeks.

 

 

 

 

 

 

 

 

CPIF Squeezing sebum out of “false pad”

 

Here is a video recorded by David Dusclos, an American dermatologist who has pioneered the use of the CO2 laser in the treatment of CPIF:-

 

 

 

 

 

 

 

 

In a case series of 27 dogs followed up after laser laser surgery for this condition, 25 had a long term cure. (Duclos DD, Hargis AM, Hanley PW: Pathogenesis of canine interdigital palmar and plantar comedones and follicular cysts, and their response to laser surgery. Vet Dermatol 2008, 19, 3, 134-141)

Here is a link to a case report published on the Vetscalpel website;-

CO2 Laser use in interdigital pododermatitis

2. The second reason I purchased the Vetscalpel CO2 laser was to be able to more effectively treat Feline Cystomatosis lesions within the ear canals compared to my diode laser. The diode laser had advantages in that can be used within water (the carbon dioxide laser cannot be used with water), but there is a risk of collateral damage which cannot show itself until a few days after the surgery and occasionally can result in full-thickness necrosis of the ear canal in the area that was lasered (however on the very rare occasions this has happened healing has been uneventful). Some of the larger Cystomatosis lesions are far better ablated using the carbon oxide laser rather than using the narrow fibreoptic tip of the diode laser.

Here is a recent video I’ve done of the CO2 laser being used for treating Feline Cystomatosis:-

 

And another one  of David Duclos’s videos showing the ablation tip of the Vetscalpel laser being used to treat some of the larger lesions of Feline Cystomatosis :-

3. The third reason for purchasing the Vet scalpel laser was to allow ablation of multiple small skin tumours without the need for sharp surgery and sutures, such as multiple sebaceous adenomas and multiple keratoacanthomas.

The cost of laser surgery is dependent on the case. For CPIF cases the cost is approximately |£1200-£1500 per foot depending on the severity/extent of the condition. For  Feline Cystomatosis cases there is a surcharge of around about £300-500  on top of the cost of general anaesthetic and video otoscopy. These charges  may appear expensive but the machine is also very expensive, but in the long term will work out cheaper than a lifetime of topical and systemic therapy and frequent visits to the vet and for Feline Cystomatosis,  total ear canal ablation which may be the only other method of treatment for would be considerably more expensive than the laser surgery and have potential risks of facial neve paralysis and draining tracts.