Low-intensity laser (660 nm) on sternotomy healing in patients who underwent coronary artery bypass graft: a randomized, double-blind study

Photobiomodulation CME part II: Clinical applications in dermatology

Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.

Trunk stabilising exercises promote sternal stability in patients after median sternotomy for heart valve surgery: a randomised trial

QUESTION

What is the effect of trunk stabilising exercises on sternal stability in women who have undergone heart valve surgery via median sternotomy?

DESIGN

Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.

PARTICIPANTS

Thirty-six women aged 40 to 50 years who had undergone heart valve surgery via median sternotomy 7 days before enrolment.

INTERVENTION

All participants in both groups received cardiac rehabilitation during hospitalisation and three times per week for 4 weeks after discharge. In addition, participants in the experimental group were prescribed a regimen of trunk stabilising exercises to be performed three times per week for 4 weeks. At each exercise session, each of 11 exercises were to be performed with five to ten repetitions.

OUTCOME MEASURES

The primary outcome was sternal separation (the distance between the two halves of the bisected sternum). The secondary outcome was the Sternal Instability Scale from 0 (no instability) to 3 (an unstable sternum with substantial movement or separation). Measures were taken before and after the 4-week intervention period.

RESULTS

After the 4-week intervention period, the experimental group had a greater decrease in sternal separation by 0.09 cm (95% CI 0.07 to 0.11). The experimental group was twice as likely to improve by at least one grade on the Sternal Instability Scale by 4 weeks (RR 2.00, 95% CI 1.07 to 3.75). The experimental group was almost three times as likely to have a clinically stable sternum (grade 0 on the Sternal Instability Scale) by 4 weeks (RR 2.75, 95% CI 1.07 to 7.04).

CONCLUSION

Trunk stabilising exercises were an effective and feasible method of promoting sternal stability in women who underwent heart valve surgery via median sternotomy.

TRIAL REGISTRATION

NCT04632914.

Effectiveness of Low-Intensity Laser Therapy on Tissue Repair Following Saphenectomy in Patients Who Underwent Coronary Artery Bypass Graft: A Randomized, Double-Blind Study

OBJECTIVE

To verify the effectiveness of low-intensity laser therapy (LLLT) on tissue repair following saphenectomy during postoperative period in patients having undergone coronary artery bypass graft (CABG).

MATERIALS AND METHODS

A randomized clinical trial, controlled and double-blind study was conducted with 40 volunteers, divided into 2 groups: a placebo group (PG, n = 20) and a laser group (LG, n = 20). The patients in the LG group were irradiated with laser during saphenectomy (InGaAlP, λ 660 nm, energy density 6 J/cm²) daily from the first to the fourth postoperative day. The surgical incision was clinically evaluated and imaged at the beginning and at the end of the treatment. The areas of hematoma and hyperemia were evaluated using the software ImageJ 1.4^©, and border closure was evaluated by three researchers, who were blinded concerning the allocation of the participants.

RESULTS

The LG group presented a reduction of the areas of hematoma and hyperemia (p = 0.0003) and better border closure (p = 0.009), when compared with the PG group.

CONCLUSIONS

The proposed LLLT protocol improved the tissue repair following saphenectomy in CABG patients.