Effects of low-level energy lasers on the healing of full-thickness skin defects

Optimal Fluence and Duration of Low-Level Laser Therapy for Efficient Wound Healing in Mice

Background

Low-level laser (light) therapy is a promising technology that stimulates healing, relieves pain and inflammation, and restores function in injured body parts. However, few studies have compared the effects of light-emitting diodes of different fluence levels or different treatment durations.

Objective

Here, we investigated the effects of various fluence levels and treatment durations on wound closure in mice.

Methods

Full-thickness wounds were created on the dorsal skin using an 8-mm diameter punch, and the wounds were irradiated at 1, 4, or 40 J/cm² for 5 consecutive days starting on day 1. To determine the optimal irradiation duration, wounds were irradiated at the most potent fluence of previous study for 5, 10, or 15 days. Photographic documentation, skin biopsies, and wound measurements were performed to compare the effects of different treatment parameters.

Results

The most effective fluence level was 40 J/cm² at day 5, as determined by monitoring wound closure. There were no statistically significant differences in wound healing with different durations.

Conclusion

We have shown that repeated exposure to low levels of light significantly stimulates wound healing in mice and demonstrated more efficient wound closure with certain fluences of 830 nm irradiation.

Low-level laser therapy (LLLT) improves alveolar bone healing in rats

The main objective of the present study was to evaluate the effect of low-level laser therapy (LLLT) in enhancing bone healing in irradiated alveolus post-tooth extraction. Sixty male Wistar rats (180 ± 10 g) were used in the present study. The left maxillary first molars were extracted, and the alveolar region was irradiated by diode laser device (GaAlAs) immediately after extraction and for more 3-day daily applications. The animals were randomly assigned into two groups: control group (n = 30, with left maxillary molar extraction-CG) and experimental group (n = 30, with tooth extraction and low-level laser therapy applied to the dental alveolus for 42 s-EG). These groups were divided into subgroups (five rats per subgroup) according to the observation time point-1, 2, 3, 5, 7, and 10 days-post-tooth extraction. The maxillary bone was separated, and the specimens were stained with hematoxylin and eosin, Masson's trichrome, and picrosirius red and immunohistochemistry for RUNX-2. Parametric and nonparametric tests were used with a significance level of 5%. LLLT accelerated bone healing with mature collagen fiber bundles and early new bone formation. Histomorphometric analysis revealed an increase of osteoblast (RUNX-2) and osteoclast (TRAP) activity and in the area percentage of cancellous bone in the lased alveolus compared to the control group. This increase was statistically significant (p < 0.05). Application of LLLT with a GaAlAs diode laser device enhanced bone healing and mineralization on alveolar region.

Wound Photobiomodulation Treatment Outcomes in Animal Models

The possibilities that photobiomodulation has brought on to the medical field are ever expanding and the scope it has reached is infinite. Determining how this relatively new treatment technique can be incorporated into the veterinary medical field is of interest to many medical professionals. In this review, we examine the treatment outcomes of low-level-laser therapy (LLLT) in different animal models to pinpoint any similarities between the studies. A search was conducted to identify LLLT studies using different animal models with an open or closed wound. The studies were compared to identify the laser parameters that resulted in positive treatment outcomes. The overall result of the studies examined indicated that daily laser exposure at a wavelength of a 600 or 800 nm range was the most beneficial across the rodent studies regardless of health status or wound type. More studies on rabbit, canine, and equine models are needed to explain the inconsistent results reviewed and find the correct treatment parameters for these species. Further research involving LLLT studies that focus on different factors including health status, treatment interval, wavelength, and energy density is needed to help validate our knowledge about the efficacy of using photobiomodulation in the veterinary medical field.

Should open excisions and sutured incisions be treated differently? A review and meta-analysis of animal wound models following low-level laser therapy

Although low-level laser therapy (LLLT) was discovered already in the 1960s of the twentieth century, it took almost 40 years to be widely used in clinical dermatology/surgery. It has been demonstrated that LLLT is able to increase collagen production/wound stiffness and/or improve wound contraction. In this review, we investigated whether open and sutured wounds should be treated with different LLLT parameters. A PubMed search was performed to identify controlled studies with LLLT applied to wounded animals (sutured incisions-tensile strength measurement and open excisions-area measurement). Final score random effects meta-analyses were conducted. Nineteen studies were included. The overall result of the tensile strength analysis (eight studies) was significantly in favor of LLLT (SMD = 1.06, 95% CI 0.66-1.46), and better results were seen with 30-79 mW/cm² infrared laser (SMD = 1.44, 95% CI 0.67-2.21) and 139-281 mW/cm² red laser (SMD = 1.52, 95% CI 0.54-2.49). The overall result of the wound contraction analysis (11 studies) was significantly in favor of LLLT (SMD = 0.99, 95% CI 0.38-1.59), and the best results were seen with 53-300 mW/cm² infrared laser (SMD = 1.18, 95% CI 0.41-1.94) and 25-90 mW/cm² red laser (SMD = 1.6, 95% CI 0.27-2.93). Whereas 1-15 mW/cm² red laser had a moderately positive effect on sutured wounds, 2-4 mW/cm² red laser did not accelerate healing of open wounds. LLLT appears effective in the treatment of sutured and open wounds. Statistical heterogeneity indicates that the tensile strength development of sutured wounds is more dependent on laser power density compared to the contraction rate of open wounds.

Influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation

OBJECTIVE

To determine the influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation (IVDH).

DESIGN

Retrospective cohort study.

ANIMALS

Dogs (n = 248) under 20 kg of weight, with single site, thoracolumbar, Hansen Type I IVDH.

PROCEDURES

Medical records of non-ambulatory dogs with IVDH treated via hemilaminectomy were reviewed. Dogs were classified in 2 groups depending on whether their postoperative management included an in-house rehabilitation program. Preoperative and sequential postoperative modified Frankel scores (MFSs) were recorded. Time to ambulation, time to normal conscious proprioception, final MFS, and complications were compared between the groups.

RESULTS

More dogs returned to full neurologic function (final MFS of Grade 5) when in-house rehabilitation was included in the postoperative management (33% compared to 9%). Normal conscious proprioception and ambulation returned earlier in the control group (42 days and 14 days, respectively) compared to the group with rehabilitation (49 days and 28 days, respectively). The complication rate was higher in the control group (29%) compared with the group with rehabilitation (16%).

CONCLUSIONS AND CLINICAL RELEVANCE

In-house rehabilitation should be included in the postoperative management in dogs after surgical treatment of IVDH to improve neurologic function and reduce postoperative complications.

Rapidly developed squamous cell carcinoma after laser therapy used to treat chemical burn wound: a case report

Background

In chronic wounds, especially burn scars, malignant tumors can arise. However, it is rare for a subacute burn injury to change to a malignant lesion within one month. Moreover, a case of squamous cell carcinoma arising from HeNe laser therapy after a chemical burn has never been reported.

Case report

In this report, we examine a rare case of squamous cell carcinoma arising from HeNe laser therapy after a chemical burn. Because pathologic investigations were made from the first operation, both early detection of the squamous cell carcinoma and consideration of the HeNe laser therapy as a risk factor for the skin cancer were possible. The cancer was completely removed and reconstruction of the defect was successfully achieved in a timely manner.

Conclusion

Although there has as yet been no reported case of squamous cell carcinoma induced by laser therapy, it is important for clinicians to recognize both the possibility of laser-induced cancer and the rapid change of cancer, so they can provide appropriate and timely treatment.

Low-level laser therapy in the treatment of mucous membrane pemphigoid: a promising procedure

BACKGROUND

Mucous membrane pemphigoid is a heterogeneous group of autoimmune, subepithelial, blistering diseases. A combination of topical and systemic steroid treatment is often used when managing patients with mucous membrane pemphigoid. The use of systemic steroids presents an increased risk of adverse side effects. Consequently, effective alternative modalities of therapy should be considered, such as the application of low-level laser therapy (LLLT).

METHODS

A patient presented with mucous membrane pemphigoid and was successfully treated with the application of local corticosteroids and LLLT using an 810-nm diode laser. The lesions were treated by LLLT over a period of 7 days using a continuous waveform for 40 seconds and an energy density of 5 J/cm(2).

RESULTS

After treatment, a significant improvement in tissue color and consistency was observed. The patient was followed every month for a period of 12 months, and the lesions healed uneventfully.

CONCLUSION

The results reported in this case show that the healing of mucous membrane pemphigoid was achieved when LLLT was used as an adjunct to the application of a local corticosteroid.

Photo-stimulatory effect of low energy helium-neon laser irradiation on excisional diabetic wound healing dynamics in Wistar rats

BACKGROUND

Generally, the significances of laser photo stimulation are now accepted, but the laser light facilitates wound healing and tissue repair remains poorly understood.

AIMS

We have examined the hypothesis that the laser photo stimulation can enhance the collagen production in diabetic wounds using the excision wound model in the Wistar rat model.

METHODS

The circular wounds were created on the dorsum of the back of the animals. The animals were divided into two groups. The study group (N = 24) wound was treated with 632.8 nm He-Ne laser at a dose of 3-9 J/cm(2) for 5 days a week until the wounds healed completely. The control group was sham irradiated.

RESULT

A significant increase in the hydroxyproline content and reduction in the wound size were observed in the study group. The pro-healing actions seem to be due to increased collagen deposition as well as better alignment and maturation.

CONCLUSION

The biochemical analysis and clinical observation suggested that 3-6 J/cm(2) laser photo stimulation facilitates the tissue repair process by accelerating collagen production in diabetic wound healing.

Lasers, stem cells, and COPD

The medical use of low level laser (LLL) irradiation has been occurring for decades, primarily in the area of tissue healing and inflammatory conditions. Despite little mechanistic knowledge, the concept of a non-invasive, non-thermal intervention that has the potential to modulate regenerative processes is worthy of attention when searching for novel methods of augmenting stem cell-based therapies. Here we discuss the use of LLL irradiation as a "photoceutical" for enhancing production of stem cell growth/chemoattractant factors, stimulation of angiogenesis, and directly augmenting proliferation of stem cells. The combination of LLL together with allogeneic and autologous stem cells, as well as post-mobilization directing of stem cells will be discussed.

The light revival: does phototherapy promote wound healing? A review

BACKGROUND

Throughout history, light has been recognised as a potential source of healing. The introduction of lasers made it possible to modify and control light for optimum therapeutic use.

AIM

This paper reviews recent clinical trials that test phototherapy on human models in order to assess the value of phototherapy in routine wound care.

METHOD

A literature search was undertaken using a variety of sources including online databases.

RESULTS

The results of numerous in vitro and animal investigations suggest that phototherapy may stimulate cell activity and promote tissue repair. Reports of human clinical trials are relatively few. There is inconsistency of selected treatment parameters amongst studies testing the effect of phototherapy on wound healing. Clinical trials using human models do not provide sufficient evidence to establish the usefulness of phototherapy as an effective tool in wound care regimes.

CONCLUSION

Further well designed research trials are required to determine the true value of phototherapy in routine wound care.

Efficacy of low-level laser therapy for chronic cutaneous ulceration in humans: a review and discussion

Chronic wounds, particularly venous ulcerations, are notoriously difficult to heal. Because current therapies are variable in their ability to induce complete healing, there remains a need to develop adjunctive treatments that can improve or accelerate the healing process. The use of low-energy lasers to stimulate wound healing has been pursued over many decades in studies of varying quality. This form of treatment has had high appeal due to its novelty, relative ease, and low morbidity profile. The authors reviewed the available published literature on low-level laser technology in an attempt to provide cumulative insight on the effect of this treatment for wound healing.

Influence of Photodynamic Therapy on the Development of Ligature-Induced Periodontitis in Rats

BACKGROUND

The purpose of this study was to evaluate, histologically and radiographically, the effect of photodynamic therapy on the progression of experimentally induced periodontal disease in rats.

METHODS

Ligatures were placed at the first mandibular molar in rats. The animals were divided into four groups: group 1 (C) received no treatment; group 2 was treated topically with methylene blue (MB; 100 microg/ml); group 3 was treated with low-level laser therapy (LLLT); and group 4 was treated topically with methylene blue followed by LLLT (4.5 J/cm(2)) (photodynamic therapy; PDT). Rats were sacrificed 5, 15, or 30 days postoperatively. Standardized radiographs were taken to measure bone loss around the mesial root surface of the first molar. Data were analyzed statistically (analysis of variance and Tukey test; P <0.05). A scoring system was used to evaluate the connective tissue, periodontal ligament, and alveolar bone histologically. Data were analyzed statistically (Kruskal-Wallis test; P <0.05).

RESULTS

Radiographic examination showed that there was significantly less bone loss in Group PDT compared to Group C at 5 and 15 days postoperatively. There was no significant difference in bone loss at 30 days. At 15 days, the histologic results showed significant differences in the extent of inflammatory reaction in the gingival tissue, with a greater extent of chronic inflammatory reaction in Group LLLT.

CONCLUSION

PDT transiently reduced the periodontal tissue destruction.

Comparison between Wound Healing in Induced Diabetic and Nondiabetic Rats after Low-Level Laser Therapy

OBJECTIVE

The aim of this work was to compare the effect of low-level laser therapy (LLLT) on the wound healing process in nondiabetic and diabetic rats.

BACKGROUND DATA

Among the clinical symptoms caused by diabetes mellitus, a delay in wound healing is a potential risk for patients. It is suggested that LLLT can improve wound healing.

METHODS

The tissue used for this study was extracted from animals suffering from diabetes, which was induced by Streptozotocin, and from nondiabetic rats. Animals were assembled into two groups of 25 rats each (treated and control) and further subdivided into two groups: diabetic (n = 15) and nondiabetic (n = 10). A full-thickness skin wound was made on the dorsum area, with a round 8-mm holepunch. The treated group was irradiated by a HeNe laser at 632.8 nm, with the following parameters: 15 mW, exposition time of 17 sec, 0.025 cm2 irradiated area, and energy density of 10 J/cm2. Square full-thickness skin samples (18 mm each side, including both injured and noninjured tissues) were obtained at 4, 7, and 15 days after surgery and analyzed by qualitative and quantitative histological methods.

RESULTS

Quantitative histopathological analysis confirmed the results of the qualitative analysis through histological microscope slides. When comparing tissue components (inflammatory cells, vessels and fibroblast/area), we found that treated animals had a less intense inflammatory process than controls.

CONCLUSION

Results obtained by both qualitative and quantitative analyses suggested that irradiation of rats with HeNe (632.8 nm), at the tested dose, promoted efficient wound healing in both nondiabetic and diabetic rats as, compared to the control group.

Endoluminal phototherapy for prevention of restenosis: preliminary results at 6-month follow-up

OBJECTIVE

The objective of this observational study was to investigate safety and efficacy of laser phototherapy (LPh) in prevention of restenosis after percutaneous coronary intervention (PCI).

BACKGROUND DATA

Laser irradiation is known to cause a limitation of the local inflammatory cascade and a stimulation of proliferation of specific cells. Based on the results of previous experiments proving the beneficial effects of laser light on the activity of vascular and inflammatory cells, we attempted to use these properties to prevent restenosis.

METHODS

Laser phototherapy was performed in 41 patients after stent implantation or balloon angioplasty. Illumination power of 100 mW and energy dose equal to 9 J/cm(2) was used. Patients were monitored for major adverse cardiac events (MACE) after 30 days and 6 months. At 6 months, angiography as a control was performed to assess the influence of LPh on restenosis rate.

RESULTS

Angiographic follow-up (n = 30) revealed restenosis in 9% and 25% of patients after stent implantation and balloon angioplasty, respectively. The MACE rate was 4.5% and 12.5% in stent and balloon-treated patients, respectively.

CONCLUSIONS

Laser phototherapy gives very promising results in restenosis prevention, especially after stent implantation. The treatment method is safe, with a low rate of MACE in follow-up.

Surface stress on the erythrocyte under laser irradiation with finite-difference time-domain calculation

The surface stress on the real shape (biconcave disklike) of an erythrocyte under laser irradiation is theoretically studied according to the finite-difference time-domain (FDTD) method. The distribution of the surface stresses depends on the orientation of erythrocytes in the laser beam. Typically when the erythrocyte was irradiated from the side direction (the laser beam was perpendicular to the normal of the erythrocyte plane), the surface stresses were so asymmetrical and nonuniform that the magnitude of the surface stress on the back surface was three times higher than that on the front surface, and the highest-to-lowest ratio of the stress reached 16 times. For comparison, the surface stress was also calculated according to the ray optics (RO) method. The tendency of the stress distribution from the RO calculation was roughly similar to that of the FDTD method. However the RO calculation produced some unphysical results, such as the infinite stress on some surface region and the zero stress on the most parts of the erythrocyte surface, which is due to the neglecting of light diffraction. The results obtained from the FDTD calculation are believed quantitatively reliable, because the FDTD method automatically takes into account of the diffraction and interference effects of the light wave. Thus, the FDTD method is more suitable than the RO method for the stress study of erythrocytes.

Emerging Modalities in Veterinary Rehabilitation

Many new modalities have been introduced in human and veterinary physical rehabilitation. In many instances, there is sound theory of how they may impact the physiology of various cells, tissues, or organs. This article reviews some of the modalities that have been introduced recently in human and veterinary rehabilitation. Topics include low-level laser, phototherapy, and extracorporeal shock wave treatment.

Burn healing with a diode laser: 670 nm at different doses as compared to a placebo group

OBJECTIVE

A study on burn healing in rats was initiated using a diode laser at varied doses for determination of optimum dosimetry and treatment schedule.

MATERIALS AND METHODS

A number of male Sprague-Dawley rats were randomly assigned to several groups. Anesthesia (a mixture of ketamine HCl and Xylocaine) was administered intraperitoneally. Burn on both flanks was created using a preheated metal probe and measured daily using a caliper. The right side of the treated rats was irradiated five times and three times per week. Slopes from the actual burn areas were obtained and compared against the control with the healing rate calculated and expressed in percent.

RESULTS

In reference to the control group, no significant difference in healing was observed. In comparing both treatment schedules, there was likewise no significant difference at any day in both age-groups. Notably in younger rats, accelerated healing was observed with the highest rate in the lower range of doses (1 and 5 J/cm2), 12.4% and 11.6%, respectively.

CONCLUSION

This experiment affirms that the beneficial effect on burn healing in rats is indeed affected by an interplay of several factors.

In Vitro Effects of Helium-Neon Laser Irradiation on Human Blood: Blood Viscosity and Deformability of Erythrocytes

OBJECTIVE

The purpose of this study was to investigate the in vitro effects of He-Ne laser irradiation on some rheological factors of human blood, such as blood viscosity, erythrocyte deformability, and sedimentation rate.

BACKGROUND DATA

The intravascular irradiation of low power laser has been applied in pre-clinical and clinical to treat various pathological processes. However, the mechanism is not fully understood so far. Especially the interaction and related mechanism between the laser and blood are unclear. In this work, by measuring the change of the main rheological factors after laser irradiation, the interaction and mechanism were explored.

METHODS

A30-mW He-Ne laser was used for irradiation with a 4-5-mm-diameter beam spot on blood samples, with a fluence rate of about 150 mW/cm.(2) The irradiation time was 60 min, so the total dose of irradiation was 540 J/cm.(2) The pathological samples of blood were obtained from patients (volunteers), and each sample was divided into two tubes for irradiation and control. The blood viscosity, erythrocyte deformability, and sedimentation rate were measured after laser irradiation and compared with un-irradiated control. The blood samples with poor erythrocyte deformability were prepared by adding Ca(2+) to the normal erythrocytes of a healthy person for investigating the laser effect on erythrocyte deformability further.

RESULTS

Laser irradiation reduced the erythrocyte sedimentation rate of blood samples, which had a hyper-sedimentation rate originally. The blood viscosity of samples in hyper-values was lowered by laser irradiation in all shear rates measured (10-110 S(-1)), with a relative variation of approximately 10%. The deformability of erythrocytes from pathological samples and Ca(2+)-treated samples was improved after laser irradiation.

CONCLUSIONS

The positive effects of laser irradiation on improving the rheological properties of blood were demonstrated in vitro.

Photohemolysis of erythrocytes by He-Ne laser irradiation: the effect of power density

The effects of He-Ne laser irradiation on erythrocyte hemolysis were studied. Erythrocytes are prone to be easily damaged with hemolysis under laser irradiation. It was found that the power density (PD) of laser irradiation, but not the total irradiation power, is the crucial parameter for the hemolysis. Under irradiation with a PD of 5.41 mW/microm(2), erythrocytes were photohemolyzed within a few seconds, while at a PD of 0.52 mW/microm(2) the average tolerance duration (TD; from the start of irradiation to hemolysis) of erythrocytes was 110 s. The TDs of erythrocytes were also individual erythrocyte-dependent, which may be due to their different ages. The average TDs of erythrocyte samples from different donors were different, reflecting individual variations.

The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study

OBJECTIVE

We used statistical meta-analysis to determine the overall treatment effects of laser phototherapy on tissue repair and pain relief.

BACKGROUND DATA

Low-power laser devices were first used as a form of therapy more than 30 years ago. However, their efficacy in reducing pain or promoting tissue repair remains questionable.

METHODS

Following a literature search, studies meeting our inclusion criteria were identified and coded. Then, the effect size of laser treatment, that is, Cohen's d, was calculated from each study using standard meta-analysis procedures.

RESULTS

Thirty-four peer-reviewed papers on tissue repair met our inclusion criteria and were used to calculate 46 treatment effect sizes. Nine peer-reviewed papers on pain control met the inclusion criteria and were used to calculate nine effect sizes. Meta-analysis revealed a positive effect of laser phototherapy on tissue repair (d = +1.81; n = 46) and pain control (d = +1.11; n = 9). The positive effect of treatment on specific indices of tissue repair was evident in the treatment effect sizes determined as follows: collagen formation (d = +2.78), rate of healing (d = +1.57), tensile strength (d = +2.13), time needed for wound closure (d = +0.76), tensile stress (d = +2.65), number and rate of degranulation of mast cells (d = +1.87), and flap survival (d = +1.95). Further, analysis revealed the positive effects of various wavelengths of laser light on tissue repair, with 632.8 nm having the highest treatment effect (d = +2.44) and 780 nm the least (d = 0.60). The overall treatment effect for pain control was positive as well (d = +1.11). The fail-safe number-that is, the number of studies in which laser phototherapy has negative or no effect-needed to nullify the overall outcome of this analysis was 370 for tissue repair and 41 for pain control.

CONCLUSIONS

These findings mandate the conclusion that laser phototherapy is a highly effective therapeutic armamentarium for tissue repair and pain relief.

The efficacy of laser therapy in wound repair: a meta-analysis of the literature

OBJECTIVE

We determined the overall effects of laser therapy on tissue healing by aggregating the literature and subjecting studies meeting the inclusion and exclusion criteria to statistical meta-analysis.

BACKGROUND DATA

Low-level laser therapy (LLLT) devices have been in use since the mid sixties, but their therapeutic value remains doubtful, as the literature seems replete with conflicting findings.

MATERIALS AND METHODS

Pertinent original research papers were gathered from library sources, online databases and secondary sources. The papers were screened and coded; those meeting every inclusion and exclusion criterion were subjected to meta-analysis, using Cohen's d. statistic to determine the treatment effect size of each study.

RESULTS

Twenty-four studies with 31 effect sizes met the stringent inclusion and exclusion criteria. The overall mean effect of laser therapy on wound healing was highly significant (d = +2.22). Sub-analyses of the data revealed significant positive effects on wound healing in animal experiments (d = +1.97) as well as human clinical studies (d = +0.54). The analysis further revealed significant positive effects on specific indices of healing, for example, acceleration of inflammation (d = +4.45); augmentation of collagen synthesis (d = +1.80); increased tensile strength (d = +2.37), reduced healing time (d = +3.24); and diminution of wound size (d = +0.55). The Fail-Safe number associated with the overall effect of laser therapy was 509; a high number representing the number of additional studies-in which laser therapy has negative or no effect on wound healing-required to negate the overall large effect size of +2.22. The corresponding Fail-Safe number for clinical studies was 22.

CONCLUSION

We conclude that laser therapy is an effective tool for promoting wound repair.

Photobiomodulation Improves Cutaneous Wound Healing in an Animal Model of Type II Diabetes

OBJECTIVE

We investigated the effects of photobiomodulation (PBM) on cutaneous wound healing in an animal model of type II diabetes, Psammomys obesus (Sand Rats).

BACKGROUND DATA

632-nm light has been established as the most effective wavelength for treatment of cutaneous wounds; however, the inconsistent efficacy of PBM may be due to inadequate treatment parameter selection.

METHODS

Using 632-nm light, an initial series of experiments were done to establish optimal treatment parameters for this model. Following creation of bilateral full-thickness skin wounds, non-diabetic Sand Rats were treated with PBM of differing dosages. Wound healing was assessed according to wound closure and histological characteristics of healing. Optimal treatment parameters were then used to treat type II diabetic Sand Rats while a diabetic control group received no irradiation. In order to elucidate the mechanism behind an improvement in wound healing, expression of basic fibroblast growth factor (bFGF) was assessed.

RESULTS

Significant improvement in wound healing histology and wound closure were found following treatment with 4 J/cm(2) (16 mW, 250-sec treatments for 4 consecutive days; p < 0.05). The 4 J/cm(2) dosage significantly improved histology and closure of wounds in the diabetic group in comparison to the non-irradiated diabetic group. Quantitative analysis of bFGF expression at 36 h post-injury revealed a threefold increase in the diabetic and non-diabetic Sand Rats after PBM.

CONCLUSIONS

The results demonstrate that PBM at an energy density of 4 J/cm(2) is effective in improving the healing of cutaneous wounds in an animal model of type II diabetes, suggesting that PBM (632 nm, 4 J/cm(2)) would be effective in treating chronic cutaneous wounds in diabetic patients.

Photobiological Basis and Clinical Role of Low-Intensity Lasers in Biology and Medicine

The purpose of this article is to provide a comprehensive review on the clinical role of low intensity laser therapy (laser photostimulation) in biology and medicine. Studies on wound healing and pain relief are highlighted to show the clinical efficacy of laser therapy. Controversies about the use of low intensity laser as a therapeutic modality for wound healing and pain relief are presented and a brief explanation is provided to overcome these controversies. The importance of standard parameters is emphasized for the applications of low intensity lasers in biology and medicine. A justification has been made to warrant further research on the use of low intensity laser as a therapeutic modality. Although the therapeutic applications of low intensity laser are imminent, the heterogeneity in treatment protocols and study design calls for a vigilant interpretation of the findings.

A comparative study of 632.8 and 532 nm laser irradiation on some rheological factors in human blood in vitro

The effects of laser irradiation with 632.8 and 532 nm on rheological properties of blood were comparatively studied in vitro. Under the irradiation condition of 30 mW, laser irradiation of blood samples using a spot diameter of 5 mm with each laser, showed promising results in the modulation of hemorheological properties. When blood samples from patients with abnormally high values of erythrocyte sedimentation rate (ESR) were irradiated, the values of ESR were lowered statistically by either of the 632.8 or 532 nm lasers. The laser irradiation reduced blood viscosities at different shear rates (10-110 S(-1)) for the hyper-viscosity blood samples. Laser irradiation increased the electrophoretic mobility (EPM) of erythrocytes when the values of the sample's EPM were abnormally slow. The erythrocyte deformability was enhanced by laser irradiation when the deformability of the sample from the patients was originally poor. For verifying the improvement of laser irradiation on erythrocyte deformability, the typical erythrocyte samples with poor deformability were produced by the pre-treatment of the erythrocytes with Ca(2+). The deformability of these erythrocyte samples was also improved after laser irradiation. These results suggest that membrane-bound hemoglobin (Hbm) might be the initial site of the interaction, since Hbm is the main cause of poor deformability when erythrocytes were treated with Ca(2+). In all experiments including ESR, blood viscosity, EPM and erythrocyte deformability, the 532 nm laser demonstrated more efficient effects on modulating rheological properties than 632.8 nm laser. This wavelength effect is consistent with the absorption spectrum of hemoglobin, reflecting that hemoglobin may be one of the action targets under laser irradiation.

Optimal dosing of intravascular low-power red laser light as an adjunct to coronary stent implantation: insights from a porcine coronary stent model

BACKGROUND

It is believed that restenosis following coronary interventions is the result of endothelial denudation that leads to thrombus formation, vascular remodeling, and smooth muscle cell proliferation. Low-power red laser light (LPRLL) irradiation enhances endothelial cell growth in vitro and in vivo, and reduces restenosis in animal models. The present study investigated the optimal dose of intravascular LPRLL therapy in the prevention of in-stent stenosis in a porcine coronary stent model.

METHODS AND RESULTS

Selected right coronary artery segments were pretreated with a LPRLL balloon, delivering a dose of 0 mW during 1 min (group 1, n = 10), 50 mW during 1 min (group II, n = 10), or 100 mW during 1 min (group III, n = 10) before stenting. Quantitative coronary analysis of the stented vessel was performed before stenting, immediately after stenting, and at 6 weeks follow-up. The pigs were sacrificed, and histologic and morphometric analyses were conducted. At 6 weeks, minimal luminal stent diameter was significantly narrower in the control group compared to the 50-mW dose group (p < 0.05). These results were confirmed by morphometric analysis. Neointimal area was also significantly decreased in the 50-mW dose group.

CONCLUSIONS

Intravascular LPRLL contributes to reduction of angiographic in-stent restenosis and neointimal hyperplasia in this animal model. The optimal dose using the LPRLL balloon system seems to be approximately 5 mW delivered during 1 min.

Low-power helium: neon laser irradiation enhances production of vascular endothelial growth factor and promotes growth of endothelial cells in vitro

BACKGROUND AND OBJECTIVE

Numerous reports suggest that low-power laser irradiation (LPLI) is capable of affecting cellular processes in the absence of significant thermal effect. The objective of the present study was to determine the effect of LPLI on secretion of vascular endothelial growth factor (VEGF) and proliferation of human endothelial cells (EC) in vitro.

STUDY DESIGN/MATERIALS AND METHODS

Cell cultures were irradiated with single different doses of LPLI (Laser irradiance from 0.10 to 6.3 J/cm(2)) by using a He:Ne continuous wave laser (632 nm). VEGF secretion by smooth muscle cells (SMC) and fibroblasts was quantified by sandwich enzyme immunoassay technique. The endothelial cell proliferation was measured by Alamar Blue assay. VEGF and transforming growth factor beta (TGF-beta) expression by cardiomyocytes was studied by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

We observed that (1) LPLI of vascular and cardiac cells results in a statistically significant increase of VEGF secretion in culture (1.6-fold for SMC and fibroblasts and 7-fold for cardiomyocytes) and is dose dependent (maximal effect was observed with LPLI irradiance of 0.5 J/cm(2) for SMC, 2.1 J/cm(2) for fibroblasts and 1.05 J/cm(2) for cardiomyocytes). (2) Significant stimulation of endothelial cell growth was obtained with LPLI-treated conditioned medium of SMC (maximal increase was observed with LPLI conditioned medium with irradiance of 1.05 J/cm(2) for SMC and 2.1 J/cm(2) for fibroblasts.

CONCLUSIONS

Our studies demonstrate that low-power laser irradiation increases production of VEGF by SMC, fibroblasts, and cardiac myocytes and stimulates EC growth in culture. These data may have significant importance leading to the establishment of new methods for endoluminal postangioplasty vascular repair and myocardial photoangiogenesis.

Low-power laser light in the healing of burns: a comparison between two different wavelengths (635 nm and 690 nm) and a placebo group

BACKGROUND AND OBJECTIVE

Studies on the influence of low-power laser light on wound healing have shown inconsistent results, or, as in the case of burns, are very scarce. We have studied the effects of two different low-power diode laser lights on the healing of burns in rats.

STUDY DESIGN/MATERIALS AND METHODS

Thirty rats were burned on both flanks and randomly allocated to one of three study groups. In group A, both wounds remained untreated; in groups B and C, one wound each was irradiated with 635 nm or 690 nm laser light (1.5 J/cm(2)), whereas the other wound remained untreated. Diameter, redness, and edema of the wounds were examined daily.

RESULTS

Between and within groups, diameter, redness, and edema of the wounds were similar throughout the entire observation period. Irradiation of the burns did not accelerate wound healing when compared with control wounds.

CONCLUSION

We conclude that neither 690 nm nor 635 nm low-power laser light produced any beneficial effects on the healing processes of burns in rats.

Helium-neon laser irradiation at fluences of 1, 2, and 4 J/cm2 failed to accelerate wound healing as assessed by both wound contracture rate and tensile strength

BACKGROUND AND OBJECTIVE

Reports in the literature indicate that low energy laser irradiation has a biostimulatory effect on wound healing; however, no mechanism of this effect has been elucidated.

STUDY DESIGN/MATERIALS AND METHODS

We attempted to establish a model from which to study the mechanism of biostimulation. The effects of low energy helium-neon irradiation on wound healing were observed in two rat models. In the first model, 1.5 cm diameter full thickness excisional skin defects were created in the dorsal midline of rats (n = 32). All animals were anesthetized and all eschars were debrided daily. Wound area was determined by caliper measurements for 2 weeks postoperatively. Rats that received a treatment of 1 J/cm2 had two defects in the dorsal skin. One wound was treated and the second was used as its own control. These measurements were not blinded. Rats that received 2 J/cm2, 4 J/cm2, or anesthesia alone had one defect on the dorsal skin. Caliper measurements of these wounds were blinded. We were unable to demonstrate any difference in the rate of wound contracture in rats that received a daily dose of 1 J/cm2, 2 J/cm2, 4 J/cm2, or anesthesia alone (P > 0.8 by student's t-test). In the second model, a single 2 cm longitudinal full thickness skin incision was created in the dorsal midline of each rat (n = 24). No difference was found between rats that received anesthesia alone and those treated daily with 2 J/cm2 as assessed by tensile strength measurements on postoperative days 7 and 14 (P > 0.8 by student's t-test between groups at both time points). These determinations were blinded.

RESULTS

Despite our intentions of studying the mechanism of low energy HeNe biostimulation, we were unable to demonstrate a beneficial effect.

CONCLUSION

In this study, helium-neon laser irradiation produced no measurable benefit on wound healing.

Effect of laser irradiation on the growth and development of fetal mouse limbs in an in vitro model

BACKGROUND AND OBJECTIVE

The purpose of the present study was to examine the effects of laser irradiation on the growth and development of fetal limb tissue.

STUDY DESIGN/MATERIALS AND METHODS

Day 14 fetal mouse limbs (n=168) were irradiated with gallium arsenide laser (904 nm, spot size=0.002 cm2, pulse duration=200 nanoseconds, peak power=30 mW) for 1 minute each day while being maintained in an organ culture system for 3 or 5 days at the following energy densities [O (control), 0.23, 1.37, 2.75, 3.66, and 4.58 J/cm2].

RESULTS

Computer image analysis of photographic images showed that there was a significant inhibition (P < 0.05) of new tissue growth after administration of lower energy densities of laser (0.23 and 1.37 J/cm2). These low-energy densities of laser irradiation also produced increased dermal cell number and collagen fiber thickness as assessed with qualitative histologic analysis of limb development by a blinded observer. Quantitative analysis of collagen distribution by color densitometric analysis of tissue sections stained with sirus red and fast green confirmed that there was a significantly greater (P < 0.05) amount of collagen present in the dermis of limbs treated with low-energy densities of laser (0.23 and 1.37 J/cm2).

CONCLUSIONS

Laser irradiation directly affected the growth and development of day 14 fetal mouse limbs in an organ culture system.

Intravascular low-power red laser light as an adjunct to coronary stent implantation: initial clinical experience

Low-power red laser light (LPRLL) irradiation enhances endothelial cell growth in vitro and in vivo and reduces restenosis in animal models. The present study reports the preliminary clinical experience in our center. Eighty-one patients were treated with LPRLL, 30 mW/1 min, for in-stent restenosis (n = 27), elective stenting for recurrent restenosis (n = 16), and stenting for treatment of a suboptimal PTCA result (n = 38). All interventions were successful and no major adverse events due to LPRLL therapy were observed. At follow-up, 12 patients (14.8%) underwent an early control coronarogram due to target vessel restenosis. At 6 months, another 20 patients showed a significant restenosis of the target vessel. Preliminary clinical evaluation demonstrates that LPRLL is feasible and safe. The preliminary results suggest that LPRLL results in a decrease of in-stent restenosis when used during primary stenting.

Healing of burns after treatment with 670-nanometer low-power laser light

Recent investigations have reported contradictory results on the influence of low-power laser light on wound healing. Low-power laser with a power output of 250 mW and an emitted laser light of 670 nm have been insufficiently investigated to date. The effect of a 250-mW/670-nm laser light on the healing of burning wounds in rats was investigated. Thirty rats were burned on both flanks. One wound was irradiated with 670-nm laser light (2 J/cm2), whereas the other side remained untreated. Macroscopic evaluation of the wounds was performed daily; 10, 20, and 30 days after burning, 10 rats were killed and the wounds histologically evaluated. Neither macroscopic nor histologic examination of the irradiated wound showed accelerated wound healing when compared with control wounds. In the present study, irradiation of burns with a 250-mW/670-nm laser light produced no beneficial effects on wound-healing processes.

Effect of low intensity monochromatic light therapy (890 nm) on a radiation-impaired, wound-healing model in murine skin

BACKGROUND AND OBJECTIVE

The use of low intensity laser and monochromatic light diodes as a therapeutic modality has become popular in a variety of clinical applications, including the promotion of wound repair. Despite this, the clinical evidence base for such application remains sparse; in contrast, recent studies have demonstrated a number of quantifiable photobiological effects associated with such therapy. In the present study, the effect of low intensity monochromatic light irradiation (MLI) at various radiant exposures upon a radiation-impaired wound model in murine skin was investigated.

STUDY DESIGN/MATERIALS AND METHODS

Male Balb/c mice (n = 50; age matched at 10 weeks) were randomly allocated to five experimental groups (n = 10 each group). In Group 1, mice were left untreated; in Groups 2-5, a well-defined area on the dorsum was exposed to 20 Gy X-ray irradiation. At 72 hours postirradiation, all mice were anaesthetised and a 7-mm-square area wound was made on the dorsum. All wounds were videotaped alongside a marker scale until closure was complete. In Groups 3-5, mice were treated with MLI (0.18, 0.54, and 1.45 J/cm2, respectively) three times weekly using a GaAlAs 890 nm multidiode (n = 60) array unit (270 Hz; maximum rated output, 300 mW; Anodyne, Denver, CO). Subsequently, the area of each wound was measured from video using an image analysis system (Fenestra 2.1), and results were analysed using repeated measure and one-factor ANOVA statistical tests.

RESULTS

X-ray irradiation caused a significant delay (P = 0.0122) in healing by day 7. MLI at 0.18 J/cm2 and 0.54 J/cm2 had no effect upon the rate of wound closure. However, a highly significant (P = 0.0001) inhibition occurred following MLI irradiation at 1.45 J/cm2 by day 16.

CONCLUSION

These findings provide little evidence of the putative stimulatory effects of monochromatic light irradiation in vivo, but, rather, reveal the potential for an inhibitory effect at higher radiant exposures.

Effect of low-intensity laser irradiation (660 nm) on a radiation-impaired wound-healing model in murine skin

BACKGROUND AND OBJECTIVE

The use of low-intensity laser therapy (LILT) as a therapeutic modality has become popular in a variety of clinical applications including the promotion of wound repair. Although the clinical evidence base for such application remains sparse, recent studies have demonstrated a number of quantifiable photobiological effects associated with such therapy. In the present study, the effect of laser irradiation at various radiant exposures on a radiation-impaired wound-healing model in murine skin was investigated.

STUDY DESIGN/MATERIALS AND METHODS

The study included two phases; in phase one, male Balb/c mice (n = 36; age-matched at 10 weeks) were randomly allocated to three experimental groups (n = 12, each group). In all groups, a well-defined area on the dorsum was exposed to 20 Gy x-rays. Seventy-two hours postirradiation, all mice were anaesthetised and a 7 x 7 mm area wound was made on the dorsum. All wounds were videotaped alongside a marker scale (three times weekly) until closure was complete. In groups 2 and 3, mice were treated with laser irradiation (0.5 and 1.5 J/cm(2), respectively) three times weekly by using a 660-nm GaAlAs laser unit (5 kHz; 15 mW; Omega Laser Systems, London, UK). Wound areas were then calculated by using an image analysis system (Fenestra 2.1), and results were analyzed by using repeated measures and one-factor analysis of variance statistical tests. In phase two, two experimental groups were included (n = 12 each group); the protocol was identical to that described for phase 1; however, mice in group 2 were treated with a radiant exposure of 4 J/cm(2).

RESULTS

Results from this investigation demonstrated that treatment with 0.5, 1.5. and 4 J/cm(2) had no beneficial effect on the rate of wound closure (P > 0.05).

CONCLUSION

These findings provide little evidence of the putative stimulatory effects of LILT in vivo at the parameters investigated.

The use of low energy photon therapy (LEPT) in venous leg ulcers: a double-blind, placebo-controlled study

BACKGROUND

Venous ulcers are estimated to be present in 0.2 to 0.4% of the population. Although new therapies have significant promise, nonhealing ulcers still represent a significant problem.

OBJECTIVE

To evaluate the efficacy of low energy photon therapy (LEPT) in the treatment of venous leg ulcers.

METHODS

A placebo-controlled, double-blind study using low energy photon therapy was performed in nine patients with 12 venous ulcers. Treatment was given three times a week for 10 weeks, using two monochromatic optical sources. One source provided a wavelength (lambda) of 660 nm (red) while the second source delivered a wavelength of 880 nm (infrared). Two optical probes were used, one consisted of an array of 22 monochromatic sources, operating at a wavelength of 660 nm and covering an area 6 x 10 cm2. The second probe had seven infrared sources, operating at a wavelength of 880 nm and covering an area of 4 cm2. The above configuration of optical probes was selected to cover the majority of the ulcer area being treated. The patients who were randomized to placebo treatment received sham therapy from an identical-appearing light source from the same delivery system.

RESULTS

Nine patients with 12 venous ulcers were randomized to receive LEPT or placebo therapy. At the conclusion of the study, the percentage of the initial ulcer area remaining unhealed in the LEPT and placebo groups was 24.4% and 84.7%, respectively (P = 0.0008). The decrease in ulcer area (compared to baseline) observed in the LEPT and placebo groups was 193.0 mm2 and 14.7 mm2, respectively (P = 0.0002). One patient dropped out of the study, complaining of lack of treatment efficacy; he was found to be randomized to the placebo group. There were no adverse effects.

CONCLUSION

In this placebo-controlled, double-blind study LEPT was an effective modality for the treatment of venous leg ulcers.

Pressure ulcers

Pressure ulcers are localized areas of tissue necrosis that result from unrelieved pressure. They are graded or staged according to the degree of tissue damage observed. The main etiologic factors include pressure, shearing forces, friction, and moisture. The clinical course may be complicated by several conditions including infection, sepsis, osteomyelitis, fistulas, and carcinoma. Preventive measures in persons at risk can significantly reduce the incidence of pressure ulcers. Successful management should address the four etiologic factors as well as the general condition of the patient.

Estudo clínico e anatomopatológico da cicatrização cutânea no gato doméstico: utilização do laser de baixa potência GaAs (904 nm)

A pesquisa avalia a ação do laser de baixa potência Arseneto de Gálio (904 nm) em feridas cirúrgicas de pele de felinos. Utilizamos 63 animais divididos em 3 grupos: A - radiados com 4J/cm2 , B - radiados com 2J/cm2 e C - controle, não radiados. A aplicação da radiação foi única no pós-operatório imediato em feridas cirúrgicas de gatas submetidas a ovariohisterectomia por conveniência. Realizamos estudo macroscópico e de microscopia de luz (Hematoxilina e Eosina) nos tempos 2º, 4º, 8º e 15º dias de pós-operatório. Obtivemos clínica e microscopicamente resultados que sugerem um incremento na cicatrização das feridas radiadas quando comparado com o grupo controle e, se mostrando vantajosa ainda a radiação com 2J/cm2 em relação a 4J/cm2. Acreditamos, portanto ser o laser um adjuvante na cicatrização cutânea, podendo otimizar a evolução de feridas pós-cirúrgicas por primeira intenção nas condições e espécie animal estudada.