During laser therapy of port wine stain (PWS) birthmarks, regions of persistent perfusion may exist. We
hypothesize that such regions, which are not readily visible, exist even during laser surgery performed by highly
experienced clinicians. The objective of this study was to use objective feedback to assess the acute vascular
response to laser therapy. We have developed a clinic-friendly laser speckle imaging (LSI) instrument to provide the
clinician with real-time images of blood flow during laser therapy. We acquired images from patients undergoing
laser therapy of PWS birthmarks at Scripps Clinic and Beckman Laser Institute and Medical Clinic. We extracted
blood flow maps from the acquired imaging data. Collectively, we have observed two regimes of patient response to
therapy: 1) an immediate increase in perfusion within minutes after laser therapy; and 2) an overall decrease in
blood perfusion approximately one hour after laser therapy, with distinct regions of persistent perfusion apparent in
the majority of post-treatment blood-flow images. A comparison of blood flow in PWS and adjacent normal skin
demonstrated that PWS blood flow can be greater than or sometimes equivalent to that of normal skin. Regions of
persistent perfusion frequently exist immediately after laser therapy of PWS birthmarks. Existence of these regions
may be correlated to the need for multiple treatment sessions to improve substantially PWS skin appearance. With
the use of intraoperative LSI, immediate retreatment of these regions may improve the outcome of each session.
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