|Posted on September 1, 2014 at 5:25 PM|
Wound can be defined as a disturbance or commotion of normal anatomical structure of a tissue and its specific function affiliated with loss of body fluid leading to infection. Healing can be defined as the restoration of anatomical continuity and function through a very well- orchestrated dynamic process regulated by certain biological molecules such as cytokines, and growth factors . Systematic progression of cells through four known phases of healing namely haemostasis, inflammation, proliferation and remodelling or maturation are thus becoming very essential for the successful acute healing process.
These chronic wounds results in both noteworthy patient morbidity and high cost to both affected individuals and the health care system. In the United States alone there were about 5 million patients suffering from chronic non-healing wounds, costing the health system $20 billion annually; this is projected to grow a further 10% each year . Some of the cost coverage is for diagnostic and surgical procedures of wounds, pharmaceuticals, wound closure devices and hospital and physician charges.
The wounds can be caused by trauma, disease, and environmental stresses or insults. The ability of the body to heal these wounds is one of the most essential defense mechanisms of the human body. However there are situations where this defense mechanism is impaired and the wounds either heal very slowly or not at all. The chronicity of the wounds is characterized by tissue destruction and impaired blood circulation that deprives the wound site of cells vital for wound healing. Such cells include macrophages, endothelial cells and fibroblasts. Examples of chronic wound include pressure ulcers, ischemic ulcers and venous ulcers .
CURRENT STANDARD TREATMENTS:
For several years there had been numerous treatments formulated to combat chronic wounds. Usually, debridement and moist wound healing are still commonly practiced treatments today. The importance of appropriate management of the wound bed is recognized as an essential part of the treatment approach to chronic wounds . Several novel approaches to managing and treating chronic wounds are continually being proposed, encompassing chemical, biological or physical treatments or even combinations of these different methodologies .
COLD LASER THERAPY:
A promising novel approach to acute and chronic wound management is through high powered laser therapy. For over 35 years, in the EU, Australia, Asia and Russia low level laser therapy (LLLT) had been an established treatment for pain and tissue repair. Regulatory approval for LLLT in the United States was given in 2002.
EFFECT OF LASER ON CELLS:
This relatively new technology has been utilized to enhance acute and chronic wound healing .The Laser and light is absorbed at the cellular level and converted into biochemical energy, thereby enhancing normal cell function and tissue repair .
MECHANISM OF ACTION:
The following sequenced events occur to bring about normal or cellular haemostasis. There is reduction of inflammation and increase collagen fibre synthesis, endothelial cell migration, proliferation and NO excretion [9, 10]. Laser light also increases the vascularity of the regenerating tissues that in turn results in more blood flow to the injury site and an increase rate of healing and tissue regeneration. As a result there is reduced scarring and control of suppurative diseases of skin or other opportunistic infections.
TREATMENT OF WOUND AREA WITH LASER:
The cold Laser therapy is accomplished using our standard wound therapy laser treatment protocols. The laser source is capable of delivering uniform power and our standard wavelength distribution covering the entire wound area under treatment. The treatment sessions are done with illumination with single exposure of pre-assigned parameters that is monitored before and after exposure to ensure proper energy delivery to the wounded site. Before each session it was confirmed that the laser beam was spread out uniformly over the entire wound including the wound boundaries. Histological samples are taken where necessary such as from chronic pressure ulcers, diabetic foot ulcers etc. etc. to monitor the healing process. Additionally the wounds are measure before and after a certain number of therapy sessions to evaluate the progress of wound healing.
All the previously mentioned sequence of event in wound healing is accomplished through optimal and effective settings of the cold laser through extensive research and patient feedback .It is very essential to utilize the combination of optimal laser treatment parameters for the most effective collagen remodelling that is a major protein responsible for normal skin tensile strength, integrity and structure. Tensile strength regeneration is one of the vital elements for successful wound healing and due to its direct role; periodic and accurate monitoring of collagen in this regard may be of direct relevance
1. J.L. Monaco and W.T. Lawrence. (2003).Clin.Plast.Surg.30, 1-12.
2. A.C.Gloria, F.D.Robert and S. S.Gregory. Wound Healing (Taylor and Francis, Florida, 2005), p.3.
3. Ablaza V & Fisher J. (1998).Telemedicine and wound care management. Home care Provid. 3(4):206-11; quiz.12-3.
4. Vodovnik I. & Karba R.(1992).Treatment of chronic wounds by means of electric and electromagnetic fields. Part 1:Literature review .Med Biol Eng Comput;30(3);257-66.
5. Schultz GS, Sibbald RG, Falanga V et al (2003). Wound bed preparation: a systematic approach to wound management. Wound Repair Regen; 11 Suppl 1:S1-28.
6. Poole-Warren I A &LyM. Wound healing. In: Akay M(Ed). Encyclopedia of BME. Hoboken. N.J: John Wiley& Sons Inc., 2006, p.3862-70.
7. Tuner J, Hode L. The Laser Therapy Handbook, Prima Books; Grandsberg, Sweden, 2002.
8. Tuner J, Hode L. The Laser Therapy Handbook, Prima Books; Grandsberg, Sweden, 2002.
9. Yasukawa A, Hrui H, Koyama Y, Nagai M & Takakuda K. The effects of low reactive-level laser therapy (LLLT) with helium-neon laser on operative wound healing in a rat model.J Vet Med Sci 20 SH07; 69(8); 799-806.
10. Chen CH, Hung HS & Hsu SH. Low-energy laser irradiation increases endothelial cell proliferation, migration and eNOS gene expression possibly via PI3K signal pathway. Lasers Surg Med 2008; 40(1):46-54.