Background and Objective: The efficacy of laser treatment of port wine stai
ns (PWS) has been shown to be highly dependent on patient-specific vasculat
ure. The effect of tissue structure on optical and thermal mechanisms was i
nvestigated for different pulse durations by using a novel theoretical mode
l that incorporates tissue morphology reconstructed tomographically from a
PWS biopsy.
Study Design/Materials and Methods: An optical-thermal numerical model capa
ble of simulating arbitrarily complex, three-dimensional tissue geometries
was developed. The model is comprised of (1) a voxel-based Monte Carlo opti
cal model, (2) a finite difference thermal model, and (3) an Arrhenius rate
process calculation to predict the distribution of thermal damage. Simulat
ions based on previous computer-based reconstruction of a series of 6 mu m
sections from a PWS biopsy were performed for laser pulse durations ( tau(p
)) of 0.5, 5.0, and 10.0 ms at a wavelength of 585 nm. Results: Energy depo
sition rate in the blood vessels was primarily a function of vessel depth i
n skin, although shading effects were evident. Thermal confinement and sele
ctivity of damage were seen to be inversely proportional to pulse duration.
The model predicted blood-specific damage for tau(p) = 0.5 ms, vascular an
d perivascular damage for tau(p) = 5 ms, and widespread damage in superfici
al regions for tau(p) = 10 ms. The effect of energy deposition in the epide
rmis was most pronounced for longer pulse durations, resulting in increased
temperature and extent of damage.
Conclusion: Pulse durations between 0.5 and 5 ms are likely optimal for the
PWS analyzed. The incorporation of a tomographically reconstructed PWS bio
psy into an optical-thermal model represents a significant advance in numer
ical modeling of laser-tissue interaction. Lasers Surg. Med. 24:151-166, 19
99. (C) 1999 Wiley-Liss, Inc.