Wound Healing Made Unlimited - WebmedCentral.com

Article ID: WMC003973 ISSN 2046-1690

Wound Healing Made UnlimitedCorresponding Author:Dr. Murtaza A Calcuttawala,Assistant Professor, Ganeral Surgery,Pad Dr D Y Patil Med College and Research Hosp., Building C4,Flat No902,Bramha Avenue,Near Jyoti Restaurant,Kondwa khurd,Pune 411048, 411048 - India

Submitting Author:Dr. Murtaza A Calcuttawala,Assistant Professor, Ganeral Surgery,Pad Dr D Y Patil Med College and Research Hosp., Building C4,Flat No902,Bramha Avenue,Near Jyoti Restaurant,Kondwa khurd,Pune 411048, 411048 - India

Article ID: WMC003973

Article Type: Case Report

Submitted on:27-Jan-2013, 09:56:25 AM GMT Published on: 28-Jan-2013, 11:03:09 AM GMT

Article URL: http://www.webmedcentral.com/article_view/3973

Subject Categories:WOUND HEALING

Keywords:Diabetic ulcer, Venous ulcer, Laser

How to cite the article:Calcuttawala MA, Hashim A, Bhatia M. Wound Healing Made Unlimited .WebmedCentral WOUND HEALING 2013;4(1):WMC003973

Copyright: This is an open-access article distributed under the terms of the Creative Commons AttributionLicense(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited.

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Competing Interests:

No competing interests

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Wound Healing Made UnlimitedAuthor(s): Calcuttawala MA, Hashim A, Bhatia M

Abstract

Background: Ten patients of lower limb ulcer admitted between October 2011 and April 2012 weretreated and studied

Material and Methods: All patients were diagnosedon the basis of clinical and radiological findings andafter that laser therapy was performed. This wasfollowed by accelerated healing of wound and in somecases by covering the wound by split thickness skingraft.

Results: All patients were male, maximum incidencewas noted in the age group of 34 to 84 years.

Conclusion: The laser therapy resulted in enhancedhealing as measured by wound contraction.

Introduction

The concept of a non-invasive, non-thermalintervention that has the power to modulateregenerative processes of the human cells is theanswer to therapist prayers in health care.

Venous ulcers, diabetic ulcers, and post-amputationwounds, are difficult to manage and often do not heal,even with aggressive medical management andpatient compliance. The lack of consistent andfavourable outcomes, is a costly and painful problemfor the patient and health care industry.

After more than 40 years of use, still no serious sideeffects of using laser radiation as a medical treatmentmodality have been observed. Low energies of laserlight affect the nature and basic mechanisms of ourcells and restore their impaired function. Some ofthese lead to accelerate wound healing, reduction ofedema, healing of neurological injuries, increasedmicrocirculation and pain relief. Laser Therapy is anew approach applicable in different medical fields,inducing soft tissue healing, pain relief, bone andnerve regeneration.

The development of pharmaceuticals has dramaticallycontributed to improve global health. However,pharmaceuticals are also creating severe side effectsfor patient and the environment.

Laser therapy is a more effective method, stimulatingcell activity to accelerate healing process than usingdifferent methods to facilitate the way for the healingprocess.

Case Report(s)

Material and Methods: All patients of lower limb ulcerand one patient of bed ulcer admitted under care ofsurgical units in various hospital in Riyadh (KSA)between October 2011 and April 2012, were treatedand studied. All patients were initially managed withconventional wound care treatment. Diagnosis wasmade on the basis of clinical presentation of patientand radiological findings.

Distribution of lower limb ulcer in different age groups ,gender,duration of ulcer and coexistant disease weredocumented.Prerequisites for laser therapy

1. Treatment area should be clean and ready2. Exact laser dose and time should be set3. Laser should be applied directly & vertically to skin,open area 5 mm away4. Treatment should be given day after day withpatient compliance until healing is achieved

Patient 1: Age 70 years old, patient diabetic andischemic, amputations since 2 months and treatmentmethod laser only, duration 6.30 minutes day after day.

Patient 2: Age 57, patient diabetic and ischemic,ulcers since 100 days, treatment method laser only,duration 6.30 minutes day after day.

Patient 3: Age 70, patient diabetic since 1 month,treatment method laser only, duration 7 minutes dayafter day.

Patient 4: Age 72, patient ischemic and diabetic type2, amputation since 8 months, treatment method laseronly, duration 7 minutes day after day.

Patient 5: Age 62, patient ischemic and diabetic type 2,amputation since 2 weeks, treatment method laseronly, duration 10 minutes day after day.

Patient 6: Age 84, patient ischemic and diabetic, bed



ulcers since 4 months, treatment method laser only,duration 7 minutes day after day.

Patient 7: Age 65, patient ischemic and diabetic, ulcersince 4 months, treatment method laser only, duration7 minutes day after day.

Patient 8: Age 34, healthy, acid ulcers since 4 years,treatment method laser only, duration 20 minutes dayafter day.

Patient 9: Age 45, diabetic and hypertension, woundsince 40 days, treatment method laser only, duration 5 minutes day after day.

Patient 10: Age 62, diabetic, Charcot foot since 6months, treatment method laser plus oral antibiotic,duration 7 minutes day after day.

How to use the machine: Switch ON from greenbutton on the back. Choose the treating tip

MS2, 7.5 mm for average wounds.

MS3, 13 mm for larger wounds.

Clean the wound with antiseptic solution. Select fromthe screen Treatment to choose manually thefrequencies and time. You can save the values bypressing save, choose patient name or MRN, writedown, then press Enter. You can call your data laterby pressing Call Data then Names. To changefrequencies and time, press Call data, names, selectthe patient’s name, change then save. To delete data,press Delete data, names, then select the patient’sname, then delete. You can use the programmedfrequencies for specific indication from the screen bypressing Indications. Select one then adjust timeaccording to the surface areas as in Time Equation. Clean the tip with alcohol swab, dry and cover it withTegaderm. Upon finishing the session, turn machineoff, discard Tegaderm and clean the tip with alcoholswab. Reclean the wound and dress it with simplegauze. Repeat the session every other day for at least13 sessions to achieve the desirable aim. By thecourse of time, you change the frequencies and timeaccording to the improvement in wound size and depth.Apply 75% of the time on 0.5 cm – 1cm margin of thewound in a back-forth manner keeping a distance tothe skin between 5-10 mm, the remaining 25% of timeon the wound bed itself in the same manner keeping adistance between 5-10 mm.

Treatment protocol: Low level laser therapy (LLLT) is

the application of the light to pathology to promotetissue regeneration, reduce Inflammation and relievepain.

Indications:

Stage III and IV bedsores

Diabetic foot

Non healing wounds

Wounds with peripheral arterial disease

Contraindications:

Patients with pace makers (at location of pace maker)

Patients with cancer

Pregnant women (at belly)

Albiminism

Epileptic patients

Undiagnosed skin lesions

No Radiation On

Open eyes

Thyroid

Child epiphysis

Open fontanel

Result: In our study all patients were male, and agegroup varied from 34 to 84 years. Six patients werefound to be having diabetic and ischemic foot while 3patients were diabetic only. One patient was a healthyadult male with acid ulcer over foot .Four patients werehaving amputation done previously. One patient waswith a bed ulcer while other one was with charcot’s joint. The duration of ulcer ranged from 2 weeks to 4years in our study. The observation were

a) skin gain back it’s healthy color,b) the Pain decreased to over 80%,c) blood flow enhanced,d) healing process triggered.



Conclusion

The exploitation of phototherapy in medicine andsurgery is of great interest, and there is a growinginterest in the use of lasers for the treatment of variousconditions and disorders, including the treatment ofdiabetic wounds . Using lasers as a source ofphotobiostimulation looks to be an attractive branch ofmedicine for the future. Due to disturbances of thecirculation in people with diabetes, wounds heal slowlyand are susceptible to infection. Laser therapy hasbeen shown to speed up the time needed for woundclosure in people with diabetes and there is improvedwound epithelialisation, increased cellular content,increased granulation tissue formation and increasedcollagen deposition. There is a decrease in theinflammatory reaction , and a stimulatory effect on theimmune system . Laser therapy has also been shownto increase microcirculation , enhance wound tensilestrength, accelerate collagen production , anddecrease free radical oxidation processes in peoplewith diabetes.

References

1. Chromey PA.The efficacy of carbon dioxide lasersurgery for adjunct ulcer therapy. Clin Podiant MedSurg. 1992;9:709-719.2. Gogia PP, Hurt BS,Zirn TT. Wound managementwith whirlpool and infrared cold laser treatment :ac l i n i c a l r e p o r t . P h y sTher.1988;68:1239-1242.[PubMed]3. Schindl A, Schindl M, Schindl L. Successfultreatment of persistent radiation ulcer by low powerl a s e r t h e r a p y . J A m A c a dDermatol.1997;37:646-648.[PubMed]4. Schindl M,Kerschan K , Schindl A, Schon H, HeinzlH, Schindl L. Induction of complete wound healing inrecalcitrant ulcers by low-intensity laser irradiationdepends on ulcer cause and size. PhotodermatolPhotoimmunol photomed. 1999;15:18-21[PubMed]5. Sugrue ME,carolan J, Leen EJ, Feeley TM, MooreDJ, Shanik GD.The use of infrared laser therapy in thetreatment of venous ulceration. Ann Vasc Surg.1990;4:179-181[PubMed]6. Baxter GD, Bell AJ, Allen JM and Ravey J (1991)Low level laser therapy: Current clinical practice inNorthern Ireland. Physiotherapy 77(3): 171-8 7. Forney R, Mauro T (1999) Using lasers in diabeticwound healing. Diabetes Technology andTherapeutics 1(2): 189-92 8. Karu TI (2003) Low level laser therapy. In: T

Vo-Dinh ed. Biomedical photonics handbook.CRCPress, Florida, USA, chapter 48: 1-25 9. Matic M, Lazetic B, Poljacki M, Duran V,Ivkov-Simic M (2003) [Low level laser irradiation andits effect on repair processes in the skin.] MedicinskiPregled 56(3-4): 137-41 10. Potinen PJ (1992) Biological effects of LLLT. In: PJPotinen, ed. Low level laser therapy as a medicaltreatment modality. Art Urpo, Tampere, Finland,99-10111. Reddy GK (2003) Compar ison of thephotostimulatory effects of visible He-Ne and infraredGa-As lasers on healing impaired diabetic rat wounds.Lasers in Surgery and Medicine 33(5): 344-51 1 2 . S c h i n d l A , H e i n z e G , S c h i n d l M ,Pernerstorfer-Schon H, Schindl L (2002) Systemiceffects of lowintensity laser irradiation on skinmicrocirculat ion in pat ients with diabet icmicroangiopathy. Microvascular Research 64(2):240-6



Illustrations

Illustration 1

Patient 1:Age 70 years old, patient diabetic and ischemic, amputations since 2 months and treatment method laser only, duration6.30 minutes day after day.



Illustration 2

Patient 2: Age 57, patient diabetic and ischemic, ulcers since 100 days, treatment method laser only, duration 6.30 minutes dayafter day.



Illustration 3

Patient 3: Age 70, patient diabetic since 1 month, treatment method laser only, duration 7 minutes day after day.



Illustration 4

Patient 4: Age 72, patient ischemic and diabetic type 2, amputation since 8 months, treatment method laser only, duration 7 minutesday after day.



Illustration 5

Patient 5:Age 62, patient ischemic and diabetic type 2, amputation since 2 weeks, treatment method laser only, duration 10 minutesday after day.



Illustration 6

Patient 6:Age 84, patient ischemic and diabetic, bed ulcers since 4 months, treatment method laser only, duration 7 minutes dayafter day.



Illustration 7

Patient 7:Age 65, patient ischemic and diabetic, ulcer since 4 months, treatment method laser only, duration 7 minutes day afterday.



Illustration 8

Patient 8:Age 34, healthy, acid ulcers since 4 years, treatment method laser only, duration 20 minutes day after day.



Illustration 9

Patient 9:Age 45, diabetic and hypertension, wound since 40 days, treatment method laser only, duration 5 minutes day after day.



How to use the machine: Switch ON from green button on the back. Choose the treating tip

Illustration 10

Patient 10:Age 62, diabetic, Charcot foot since 6 months, treatment method laser plus oral antibiotic, duration 7 minutes day afterday.



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Wound Healing Made Unlimited - WebmedCentral.com