Healing process of laser-welded intestinal anastomosis

Low-level laser irradiation promotes cell proliferation and mRNA expression of type I collagen and decorin in porcine Achilles tendon fibroblasts in vitro

Achilles tendon problems are commonly encountered in sports medicine and low-level laser therapy (LLLT) is widely used in rehabilitative applications to decrease pain, reduce inflammatory processes, and promote tissue healing. This study examined the effects on the proliferation of porcine Achilles tendon fibroblasts and gene expression, using different doses of low-level laser irradiation (LLLI). Four groups of identically cultured fibroblasts were exposed to LLLI and harvested after 24 h. The control group (Group 1) was subjected to no LLLI. Other groups received 1 J/cm2 (Group 2), 2 J/cm2 (Group 3), and 3 J/cm2 (Group 4), respectively. Cell proliferation and mRNA expressions of type I collagen and decorin were then measured. When compared to the control group, the cell proliferation of irradiated Achilles tendon fibroblasts in the other three groups increased significantly by 13% +/- 0.8% (Group 2), 30% +/- 0.4% (Group 3), and 12% +/- 0.6% (Group 4) respectively. But progressively higher laser intensity did not achieve a correspondingly higher cell proliferation effect in Achilles tendon fibroblasts. The mRNA expressions of decorin and type I collagen in fibroblasts with LLLI were significantly higher (p < 0.05). Therefore, suitable dosages of LLLI may result in more effective tissue healing by promoting type I collagen and decorin synthesis. However, these positive effects of LLLI on the repair of the Achilles tendon in humans should be further investigated in clinic.

Effect of nonablative laser energy on the joint capsule: an in vivo rabbit study using a holmium:YAG laser

BACKGROUND AND OBJECTIVE

The nonablative application of holmium:yttrium-aluminum-garnet (Ho:YAG) laser energy to the joint capsule of patients with glenohumeral instability has been found to shrink capsular tissue and to help stabilize the joint. The purpose of this study was to evaluate the effect of nonablative laser energy on the short-term histological properties of joint capsular tissue in an in vivo rabbit model.

STUDY DESIGN/MATERIALS AND METHODS

Eighteen mature New Zealand white rabbits were used in this study. One randomly selected stifle was treated with laser energy, and the contralateral stifle was sham-operated. Animals were euthanized immediately after surgery (day 0), at 7 days postsurgery and 30 days postsurgery. Specimens were processed for histology and transmission electron microscopy.

RESULTS

Laser-treated samples at day 0 showed diffuse hyalinization of collagen with nuclear karyorrhexis of fibroblasts. Laser-treated tissue at 7 days postsurgery revealed fibroblast proliferation around and into acellular hyalinized regions of collagen. At 30 days postlaser treatment, areas of fused collagen were greatly reduced as large reactive fibroblasts migrated and secreted matrix.

CONCLUSION

This study illustrates the short-term in vivo tissue response to nonablative laser treatment, where acellular hyalinized regions of collagen are infiltrated by fibroblasts that have used the treated collagen as the framework for migration and secretion of new collagen matrix in order for tissue repair to proceed.

Controlled temperature tissue fusion: argon laser welding of rat intestine in vivo. Part one

BACKGROUND AND OBJECTIVE

Thermal denaturation of proteins is recognized as a rate process governed by the local temperature-time response. Since rate processes are exponential with temperature, laser-assisted tissue welding was performed with and without temperature feedback control (TFC) to investigate the efficacy of temperature feedback in enhancing the photothermal welding process in vivo.

STUDY DESIGN/MATERIALS AND METHODS

An automated system was developed for temperature feedback controlled laser irradiation. An experimental device incorporating co-aligned laser delivery and temperature detection was used to perform argon laser welded (with and without TFC) enterotomies. The weld strength and histology of laser welded and control sutured enterotomies were compared in an in vivo rat model. Animals (n = 41) were sacrificed at 1, 3, 7, and 21 days postoperatively, and the anastomotic site was removed for bursting/leaking pressure measurements and histological examination.

RESULTS

Laser-welded (with and without TFC) and control sutured anastomoses in surviving animals healed comparably. Some laser-welded anastomoses without TFC ruptured spontaneously (4 out of 15) leading to the animals' death within the first 24-36 hours postoperatively. None of the animals in the other groups had this problem (control suture 0/6; laser with TFC 1 leak/8). The bursting/leaking pressures of the laser welded anastomoses were not significantly different than those of the sutured controls.

CONCLUSION

TFC improves the quality of laser-welded rat intestinal anastomoses in vivo in the critical first postoperative 36 hours.

Comparison of dermal and epithelial approaches to laser tissue soldering for skin flap closure

BACKGROUND AND OBJECTIVE

Prior studies of laser tissue soldering (LTS) of epithelial skin have shown poor wound strength in the short-term; however, we hypothesize that greater tensile strength and healing properties will result from directing laser energy to the dermal aspect of the skin. The current study compares wound strength and histology in a rat skin flap model of epithelial and dermally applied LTS.

STUDY DESIGN/MATERIALS AND METHODS

Skin flaps (2.5 x 4 cm) were raised and bisected on the dorsum of Sprague-Dawley rats. The center line of bisection was closed from a dermal approach by LTS (LTS-D, diode laser 15.9 W/cm2 + Columbia solder), the upper incision by epithelial LTS (LTS-E), and the lower incision by suturing (7-0 Vicryl). Wound skin strips (1-2 mm x 10 mm) were studied immediately (N = 14) and at 3 (N = 57), 7 (N = 31), and 10 (N = 28) days postoperatively and were subjected to tensiometric analysis. Histologic staining with hematoxylin and eosin and Mallory's trichrome methods were used to define wound architecture.

RESULTS

No wound dehiscences were noted in any group. Greater immediate tensile strength was noted in wounds closed by LTS-D (521 +/- 61 g/cm2) versus LTS-E (342 +/- 65 g/cm2); however, this difference was not statistically significant (P = .08). By 3 days, both LTS-D (476 +/- 55 g/cm2) and LTS-E (205 +/- 37 g/cm2) maintained their initial strength; however, LTS-D and sutured (436 +/- 49 g/cm2) wounds were stronger (P < .05) than LTS-E. At 7 and 10 days, LTS-D (2,433 +/- 346 g/cm2 and 3,100 +/- 390 g/cm2) showed superior tensile strength (P < .05) compared to both LTS-E (1,542 +/- 128 g/cm2 and 2,081 +/- 219 g/cm2) and suturing (1,342 +/- 119 g/cm2 and 1,661 +/- 115 g/cm2). Histologic analysis of LTS-D wounds at 3 days showed full-thickness tissue apposition, complete epithelialization, and minimal inflammation or thermal injury. At 7 days, solder was present in the wounds. In contrast, LTS-E wounds at 3 days displayed lack of epithelialization secondary to thermal injury and partial-thickness tissue apposition. However by 7 days, epithelialization was complete with moderate scarring, and no solder was seen. Sutured samples appeared similar to LTS-D, except for poorer tissue apposition at the hypodermis.

CONCLUSION

Our results show that skin flap wound healing after dermal LTS is superior to epithelial LTS and emphasizes the importance of site specificity in the utilization of this operative technique in reconstructive surgery.

Recent advances in the use of lasers in otolaryngology

The laser (Light Amplification by Stimulated Emission of Radiation) has been used in Otolaryngology for over 20 years and is by now an accepted part of the armamentarium. A tremendous amount of work is being done in refining existing techniques and developing new ones, and this review discusses some of the recent advances.

The effect of nonablative laser energy on joint capsular properties. An in vitro histologic and biochemical study using a rabbit model

The purpose of this study was to evaluate the effect of laser energy at nonablative levels on joint capsular histologic and biochemical properties in an in vitro rabbit model. The medial and lateral portions of the femoropatellar joint capsule from both stifles of 12 mature New Zealand White rabbits were used. Specimens were divided into three treatment groups (5 watts, 10 watts, and 15 watt) and one control group using a randomized block design. Specimens were placed in a 37 degrees bath of lactated Ringer's solution and laser energy was applied using a holmium:yttrium-aluminum-garnet laser in four transverse passes across the tissue at a velocity of 2 mm/sec with the handpiece set 1.5 mm from the synovial surface. Histologic analysis revealed thermal alteration of collagen (fusion) and fibroblasts (pyknosis) at all energy densities, with higher laser energy causing significantly greater morphologic changes over a larger area (P < 0.05). Application of laser energy did not significantly alter the biochemical parameters evaluated, including type I collagen content and nonreducible crosslinks (P > 0.05). This study demonstrated that nonablative laser energy caused significant thermal damage to the joint capsular tissue in an energy-dependent fashion, but type I collagen content and nonreducible crosslinks (P > 0.05). This study demonstrated that nonablative laser energy caused significant thermal damage to the joint capsular tissue in an energy-dependent fashion, but type I Collagen content and nonreducible corsslinks were not significantly altered.

Prevention of pharyngocutaneous fistulas by means of laser-weld techniques

Although much has been written on methods of dealing with pharyngocutaneous fistulas once they have formed, there are few reports of methods of preventing fistula formation from occurring. We examined the use of laser-weld techniques with the neodymium:yttrium aluminum garnet (Nd:YAG) and diode lasers to seal pharyngotomy closures. Laser-weld techniques have been used successfully in many other tissues, but reports documenting use in the upper aerodigestive tract are minimal. Indocyanine-green dye-enhanced collagen and fibrinogen were studied as laser solder materials for the diode laser. Twenty-nine experimental animals were studied. Neither the Nd:YAG nor the diode laser was successful in preventing fistula formation. Tensiometric studies documented significant strength of the laser welds ex vivo, but this finding was not clinically significant.