Hi All,

After Ron S., Del and I chatted about the different appearances in these similar lesions, I have a few thoughts:

1.  Fibromas are not very vascular–being made up of mostly collagen.  Erbiums cut collagen very well.  So using an erbium with water and in contact will cause a  nice CUT through the collagen fibers.

2.  If you pull hard on the fibroma and streeetch the fibers out–THEN cut through–when the fibroma releases there will be more of that “crater” appearance (which I try to obtain).

3.  Ron K. has demonstrated a very EXCELLENT technique of using the erbium to replicate a “punch” excisional biospy involving the peripheral borders.

Since Ron has gone into deeper, and therefore more vascular tissues with much LARGER capillary diameter than in and near the fibroma proper, AND using a none-hemostatic wavelength to include the margins for histologic assessment, there is much more tendency to bleed (but almost ZERO Zone of lateral thermal Injury).  When Ron defocuses, turns off the water, uses light air to blow the pooling blood away from the capillary ends, he can get enough HEAT to char the surface (like a CO2 laser).  That get him his hemostasis (along with a little pressure for the deeper aspects of that capillary bed).  The thermal wound “injury” is very superficial–even though it looks crispy, it feels very comfortable to he patient as the c-fibers nerve endings are coagulated (necrosed).

My 2 cents…….

Bob

I’ll try again(man, I thought i figured this out)

finally the pre op of the fibroma.