Laser resurfacing has recently been questioned by Alster8. Her findings are particularly relevant to Erbium:YAG laser resurfacing wounds that are often limited to cosmetic units, healing faster and do not contain a layer of thermally damaged devitalized tissue that serves as a nidus for infection in CO2 resurfaced patients. The prolonged wound healing in CO2 laser resurfaced patients, along with the use of pre-operative prophylactic antibiotics in these patients may contribute to super-infection with resistant organisms, including gram-negative bacteria and yeasts. Although Fitzpatrick found no benefit from the use of prophylactic mupirocin ointment to the nares of CO2 laser patients9, we found it adequate to prophylax Erb:YAG laser resurfacing patients, along with the use of good post-op patient wound care hygiene and the broad spectrum antimicrobial wound cleanser,

Clinical Care: The use of Clinical Care post-operatively, was beneficial not only in reducing the incidence of infection but in atraumatically debriding wound exudate. This unique emulsifying antibacterial and antiyeast solution covers S. aureus, MRSA, S. pyogenes, S. typhimurium, P. aeruginosa, E-coli, K. pneumonia, Aspergillus, and Candida albicans. The contact urticarial reaction experienced by three patients at the onset of the study (Table1) was solved by reduction of DMDM hydantoin, a known contact allergen,10 by 50% from the final product. No further stinging, burning or skin reactions were noted.

The Oxy-Mist spray system post-laser resurfacing has been used successfully post CO2 laser resurfacing with good success11. One of the most remarkable advantages of the protocol described above was virtual elimination of post-operative pain. In our experience, the use of other open healing systems, irregardless of the ointment used, are associated with considerable pain. Phone calls to patients using a variety of open systems the day of and subsequent day often revealed moderate burning discomfort requiring use of oral analgesics. The use of the biO2 system virtually eliminated the need for post-op analgesics and patients typically reported minimal or no pain the evening after the procedure. The reasons for pain reduction are not clear, but may be related to sealing of exposed cutaneous sensory nerve endings by one of the components in Oxy-Mist spray.

In clinical studies the synergy of oxygen and the other Oxy-Mist ingredients accelerates the re-epithelization process, improving cellular supply of oxygen and providing conditions favorable to collagen formation and scar inhibition. It is well recognized that healing in hypoxic wounds and low nutrient levels can be improved if the supply of oxygen and other nutritive substances is increased.

The post-operative use of light-blue tinted white petrolatum was perceived by the patients to have a cooling effect on the skin. This factor, plus the hands on daily contact by our nursing staff, provided a sense of security for our patients and allowed us to monitor them throughout their post-operative period. This daily contact with patients aids in not only the wound healing of their skin but provides significant psychological benefits including positive feedback about their healing and conveys the impression that they are not abandoned after their laser procedure is done and their fee paid. These patients reported a high degree of satisfaction with their laser resurfacing procedure and our staff.

The cost of biO2 treatments, and post-operative nursing care us estimated to be approximately $13.50 per day. In our office, these costs are built into the cost of the laser procedure which also includes preoperative skin conditioning treatments.

Ideally, we felt that biO2 treatments could be done by an office nurse visiting the patient at home. Surprisingly, however, when this option was offered to patients they preferred to get out of the house every day and be treated in office to avoid the feeling of "cabin fever".

Immediate complications from this system were quite unusual and included occasional mild stinging and burning after the first session. The three patients (Table1) who were unable to tolerate Oxy-Mist spray and were forced to discontinue their treatments experienced difficulties only after they developed a contact urticatial like reaction to Clinical Care solution. Other complications seen, such as post-laser acne (Table1) were most likely related to the use of petrolatum and occurred commonly after laser resurfacing irregardless of the wound healing system utilized.

In summary, we have described the use of a modified biO2 post-laser resurfacing protocol. This modified regimen differs significantly from the normal biO2 protocol (Fig. 1) by the addition of Clinical Care, which adds broad-spectrum antimicrobial coverage to the process. It also emphasizes minimal cleansing and scrubbing post-operatively. This protocol, in our hands has been quite effective in healing patients after even aggressive Erbium:YAG laser resurfacing. Most importantly, we feel this system allows daily interaction between patient and nursing staff during the critical post-operative period, thus reducing the risk of unforeseen complications and enhancing the patient's entire resurfacing experience.