Wound Care, Wound Healing, Diabetic Ulcerations: High Power Laser Therapy a New Treatment Approach
Our office uses a multifaceted non medical approach to treating peripheral neuropathy. This includes many patients that were not able to take standard neuropathy medicine such as Neurotin, Lyrica and Cymbalta due to the side effects. In addition we see patients who at first were able to be managed with these medications however the treatment dose has been increased to the maximum and the patient continues to have increase symptoms. As such we see our share of diabetic and kidney disease patients with diabetic ulcers and wound care issues. Many are treating these diabetic ulcer and slow healing wounds in wound care centers which may include hyperbaric oxygen. They are however unaware that laser therapy has been show to accelerate tissue growth and repair, reduce inflammation, improve vascular activity, reduce scar tissue and improve wound healing by stimulating fibroblast development and collagen production. Below are 2 recent articles from the scientific literature regarding Laser Therapy and wound healing.
Laboratory of Experimental Pathology, Oswaldo Cruz Foundation, Rua Waldemar Falcão, 121, Salvador, Bahia 40.296-710, Brazil.
The modulation of collagen fibers during experimental skin wound healing was studied in 112 Wistar rats submitted to laser photobiomodulation treatment. A standardized 8mm-diameter wound was made on the dorsal skin of all animals. In half of them, 0.2ml of a silica suspension was injected along the border of the wound in order to enhance collagen deposition and facilitate observation. The others received saline as vehicle. The treatment was carried out by means of laser rays from an aluminum-gallium arsenide diode semiconductor with 9mW applied every other day (total dose=4J/cm2) on the borders of the wound. Tissue sections obtained from four experimental groups representing sham-irradiated animals, laser, silica and the association of both, were studied after 3, 7, 10, 15, 20, 30 and 60 days from the laser application. The wounded skin area was surgically removed and submitted to histological, immunohistochemical, ultrastructural, and immunofluorescent studies. Besides the degree and arrangement of collagen fibers and of their isotypes, the degree of edema, the presence of several cell types especially pericytes and myofibroblasts, were described and measured. The observation of Sirius-red stained slides under polarized microscopy revealed to be of great help during the morphological analysis of the collagen tissue dynamic changes. It was demonstrated that laser application was responsible for edema regression and a diminution in the number of inflammatory cells (p<0.05). An evident increase in the number of actin-positive cells was observed in the laser-treated wounds. Collagen deposition was less than expected in silica-treated wounds, and laser treatment contributed to its better differentiation and modulation in all irradiated groups. Thus, laser photobiomodulation was able to induce several modifications during the cutaneous healing process, especially in favoring newly-formed collagen fibers to be better organized and compactedly disposed.
The purpose of the study is to assess the effectiveness of low level laser therapy for wound healing when combined with the Extendicare Wound Prevention and Management Program. Sixteen residents at a Canadian Extendicare nursing home had a total of 27 sites treated consisting of 23 open wounds and 4 'at risk' areas. Of the 23 open wounds, two wounds in between toes were not able to be 'traced' and deemed 'immeasurable' wounds, resulting in 21 open, measured wounds. The four 'at risk' (closed) areas were treated preventatively. Pressure, venous insufficiency and diabetic wounds were included. The majority (12/21) or 57.1%, of the wounds were chronic (>or=3 months duration) and 42.9% were acute (<3 months duration). The primary outcome measures included the PUSH Tool score, EZ Graph tracings and photographs. Secondary outcome measures were employed to better understand potential barriers to successful integration into clinical practice. Feedback on the effectiveness of low level laser therapy, the education program and determinations of hands-on relevance was sought from staff. At the end of the 9-week trial, the majority (61.9%) of the 21 wounds achieved significant improvement (>or=50% wound closure). Nine (42.8%) had 100% closure. Some improvement was seen in 14.3% and 23.8% of wounds demonstrated no change. Chronic and acute wounds had similar improvement. None of the wounds in this debilitated, frail population deteriorated during the study and no negative consequences of treatment were encountered. Without staff support, even if new technology has positive clinical outcomes, success would be limited. Staff rated low level laser, easy to learn and use, effective for the majority of their residents worth the additional time. Staff requested a continuation of low level laser even after study completion.
High Power Laser Therapy allows for deeper penetration and saturation of target tissue (in Diabetic ulcers) and has provided us successful outcomes. If you have not had success or limited success with traditional treatments in the wound care realm then High Power Laser Therapy is something you should consider.
Dr. Mane offers one on one consultation for those who suffer with diabetic ulcerations or wound care issues. If you are interested in scheduling a consultation please call 813-935-4744.
For information about Dr. Nelson Mane, D.C and his treatment approach go to http://manecenter.com
(ArticlesBase SC #740760)
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