The abstracts below show a selection of types of wound in which low level laser, as well as low level ultrasound, have proven to be effective. The abstracts also point out the many ways in which healing is brought about.

Visible Light-Induced Healing of Diabetic or Venous Foot Ulcers: A Placebo-Controlled Double-Blind Study

Zvi Landau, Michal Migdal, Anat Lipovsky, Rachel Lubart. Photomedicine and Laser Surgery. doi:10.1089/pho.2010.2858

Background and objectives: Non-healing ulcers represent a significant dermatological problem. Recently, conventional therapy-resistant chronic ulcers have been treated with low energy lasers or light-emitting diodes in the visible and near IR region, but only a few placebo-controlled double-blind studies have been performed to support the efficacy of this approach. The aim of the present study was to evaluate the efficacy of a broadband (400–800 nm) visible light device in the treatment of leg or foot ulcers. Methods: A placebo-controlled double-blind study using broadband light source (400–800 nm) was performed on patients with diabetic foot ulcers or patients with chronic leg ulcers. The treatment group was illuminated with 180 mW/cm2 broadband light twice a day for 4 min/session, while patients in the placebo group received non- healing light fluency (10 mW/cm2) projections. The treatment group included 10 patients with a total of 19 ulcers, whereas in the placebo group, 6 patients had 6 ulcers. The follow-up period was 12 weeks. Results: At the end of the follow up, all the wounds were closed in 9 out of 10 patients (90%) from the treatment group, whereas in the placebo group only 2 out of 6 patients exhibited closed wounds (33%). The reduction in wound size in the treatment group versus the placebo group was 89% and 54%, respectively. Conclusions: In this small scale placebo-controlled double-blind study, broadband (400–800 nm) visible light was an effective modality for the treatment of leg or foot ulcers.

A Randomized Clinical Trial on the Effect of Low-Level Laser Therapy on Chronic Diabetic Foot Wound Healing: A Preliminary Report

Ahmad Kaviani, Gholamreza Esmaeeli Djavid, Leila Ataie-Fashtami, Mohsen Fateh, Maryam Ghodsi, Maliheh Salami, Nasrin Zand, Nasim Kashef, Bagher Larijani. Photomedicine and Laser Surgery. February 2011, 29(2): 109-114. doi:10.1089/pho.2009.2680

Background and Objectives: Low-level laser therapy (LLLT) has been shown to promote chronic wound healing in conditions of reduced microcirculation. In this preliminary study, we report the results of using LLLT to heal foot ulcers in patients with diabetes mellitus. Materials and Methods: Twenty-three patients with a diabetic foot wound for at least 3 months were included in this double-blind randomized clinical trial. Patients were randomized to receive placebo treatment (n = 10) or LLLT (n = 13) (685 nm, energy density 10 J/cm2) in addition to conventional therapy. Patients were followed for 20 weeks. Ulcer size reduction and the number of patients with complete healing were compared between the LLLT and placebo groups. Results: There were no significant differences in baseline characteristics of patients and foot ulcers receiving LLLT and placebo treatment. At week 4, the size of ulcers decreased significantly in the LLLT group (p  = 0.04). After 20 weeks, in the LLLT group, eight patients had complete healing and in the placebo group only three patients experienced complete wound healing. The mean time of complete healing in LLLT patients (11 weeks) was less than that in placebo patients (14 weeks) though the difference was not statistically significant. Conclusions: The study provides evidence that LLLT can accelerate the healing process of chronic diabetic foot ulcers, and it can be presumed that LLLT may shorten the time period needed to achieve complete healing.

Low-Level Laser Therapy (LLLT) Efficacy in Post-operative Wounds

Nicoleta Herascu, Bogdan Velciu, Mihaela Calin, Dan Savastru, Camelia Talianu. Photomedicine and Laser Surgery. February 2005, 23(1): 70-73. doi:10.1089/pho.2005.23.70

Objective: The aim of this paper was to investigate the efficacy of low-level laser radiation (LLLR) with wavelength of 904 nm on the stimulation of the healing process of postoperative aseptic wounds (early scar). Background Data: Low-level laser therapy (LLLT) has been increasingly used to treat many disorders, including wounds. However, despite such increased clinical usage, there is still controversy regarding the efficacy of this wound treatment in curent clinical practice. Methods: LLLT has been used to treat cutting plague in the right instep and on the left foot. Both resulted from sutured wounds. The clinical evaluation by semiquantitative methods is presented. Results: Clinical evaluation showed that the healing process of these postoperatively treated wounds has occurred and that the functional recovery of the patients (i.e., return to their ordinary life) was faster than without treatment. Conclusion: LLLR with wavelength of 904 nm to stimulate postoperative aseptic wounds (early scar) is efficient in both cases of cutting plague.

Phototherapy promotes healing of chronic diabetic leg ulcers that failed to respond to other therapies

Debora G. Minatel PT, PhD, Marco Andrey C. Frade MD, PhD, Suzelei C. França PhD, Chukuka S. Enwemeka PhD, FACSM. Lasers Surg. Med. 41:433–441, 2009

Objective: We tested the hypothesis that combined 660 and 890 nm LED phototherapy will promote healing of diabetic ulcers that failed to respond to other forms of treatment. Research Design and Methods: A double-blind randomized placebo controlled design was used to study 23 diabetic leg ulcers in two groups of 14 patients. Group one ulcers were cleaned, dressed with 1% silver sulfadiazine cream and treated with “placebo” phototherapy (<1.0 J cm−2) twice per week, using a Dynatron Solaris 705® device. Group two ulcers were treated similarly but received 3 J cm−2 dose. Results: At each of 15, 30, 45, 60, 75, and 90 days of healing, mean ulcer granulation and healing rates were significantly higher for group two than the “placebo” group (P < 0.02). While “placebo” treated ulcers worsened during the initial 30 days, group two ulcers healed rapidly; achieving 56% more granulation and 79.2% faster healing by day 30, and maintaining similarly higher rates of granulation and healing over the “placebo” group all through. By day 90, 58.3% of group two ulcers had healed fully and 75% had achieved 90–100% healing. In contrast, only one “placebo” treated ulcer healed fully by day 90; no other ulcer attained ≥90% healing. Conclusion: Combined 660 and 890 nm light promotes rapid granulation and healing of diabetic ulcers that failed to respond to other forms of treatment.

The Effects of Low Level Laser Irradiation on Gingival Inflammation

Ana Pejcic, Draginja Kojovic, Ljiljana Kesic, Radmila Obradovic. Photomedicine and Laser Surgery. February 2010, 28(1): 69-74. doi:10.1089/pho.2008.2301

Objective: The goal of this study was to analyze the effects of low level laser irradiation treatment and conservative treatment on gingival inflammation. Background: It is widely accepted today that the primary etiological factor for the onset of periodontitis is dental plaque, although the exact mechanism of damage remains unknown. Inflammation is a basic response of periodontal tissue to damage and serves as a fast first line of defense against damage and infections. The treatment of gingivitis and periodontitis has gone through various stages: from the simplest, classical treatment methods, through improved radical interventions, to a new era marked by laser technology. Low level laser irradiation has an anti-inflammatory effect, both general and local. Materials and methods: The research was done on patients who had chronic periodontal disease (mild periodontitis) with expressed clinical symptoms of gingival inflammation. All patients in the study underwent conservative treatment. After conservative therapy, the patients from the experimental group were subjected to 10 low level laser treatment sessions. Both groups underwent regular follow-up visits 1, 3, and 6 months after treatment, which involved only clinical examination using plaque index (PI), gingival index (GI), and bleeding on probing index (BOP index). Results: A considerable decrease in all three indexes after the application of both therapies was noticed. The follow-up visits revealed the difference in index values. With laser therapy, the values of indexes decreased steadily, whereas with conservative therapy they increased up to a certain point, but did not reach the pre-therapy values. Conclusions: A general conclusion can be drawn that low level laser irradiation (semiconductor, 670 nm) can be used as a successful physical adjuvant method of treatment, which, together with traditional periodontal therapy, leads to better and longer-lasting therapeutic results.

Effects of Low-Level Laser Therapy on Pain and Scar Formation After Inguinal Herniation Surgery: A Randomized Controlled Single-Blind Study

Rodrigo Leal de Paiva Carvalho, Paulo Sérgio Alcântara, Fábio Kamamoto, Marcela Dalla Costa Cressoni, Raquel Aparecida Casarotto. Photomedicine and Laser Surgery. June 2010, 28(3): 417-422. doi:10.1089/pho.2009.2548

Objective: The aim of this study was to investigate the efficacy of an infrared GaAlAs laser operating with a wavelength of 830 nm in the postsurgical scarring process after inguinal-hernia surgery. Background: Low-level laser therapy (LLLT) has been shown to be beneficial in the tissue-repair process, as previously demonstrated in tissue culture and animal experiments. However, there is lack of studies on the effects of LLLT on postsurgical scarring of incisions in humans using an infrared 830-nm GaAlAs laser. Method: Twenty-eight patients who underwent surgery for inguinal hernias were randomly divided into an experimental group (G1) and a control group (G2). G1 received LLLT, with the first application performed 24 h after surgery and then on days 3, 5, and 7. The incisions were irradiated with an 830-nm diode laser operating with a continuous power output of 40 mW, a spot-size aperture of 0.08 cm2 for 26 s, energy per point of 1.04 J, and an energy density of 13 J/cm2. Ten points per scar were irradiated. Six months after surgery, both groups were reevaluated using the Vancouver Scar Scale (VSS), the Visual Analog Scale, and measurement of the scar thickness. Results: G1 showed significantly better results in the VSS totals (2.14 ± 1.51) compared with G2 (4.85 ± 1.87); in the thickness measurements (0.11 cm) compared with G2 (0.19 cm); and in the malleability (0.14) compared with G2 (1.07). The pain score was also around 50% higher in G2. Conclusion: Infra-red LLLT (830 nm) applied after inguinal-hernia surgery was effective in preventing the formation of keloids. In addition, LLLT resulted in better scar appearance and quality 6 mo postsurgery.

The Efficacy of Low-Power Lasers in Tissue Repair and Pain Control: A Meta-Analysis Study

Chukuka S. Enwemeka, Jason C. Parker, David S. Dowdy, Erin E. Harkness, Leif E. Harkness, Lynda D. Woodruff. Photomedicine and Laser Surgery. August 2004, 22(4): 323-329. doi:10.1089/pho.2004.22.323

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.

Therapeutic Ultrasound in Lower Extremity Wound Management

Christine Uhlemann, MD, Birgit Heinig, Dipl-Med, Uwe Wollina, MD. International Journal of Lower Extremity Wounds September 2003 vol. 2 no. 3 152-157

In medical practice, ultrasound (US) is used for diagnosis and therapy. High-frequency (1-4 MHz) and low-frequency (20-120 KHz) therapeutic US are relevant to wound healing. The heating effects of high-frequency US are important, whereas the mechanical effects of low-frequency US must be considered. The physiological effects of low-frequency US include metabolic enhancement, perfusion, wound cleansing, and the acceleration of wound granulation. The therapeutic efficacy of US depends on dose (W/cm 2 time)and dosage (frequency of application, series). At adequate doses, high-frequency and low-frequency therapeutic US induce in vitro cell proliferation; protein synthesis; and the production of cytokines by fibroblasts, osteoblasts, and monocytes. The mechanical effects of low-frequency US cause transient cavitation in wound surfaces for soft and smooth wound cleaning, ulcer debridement, and the stimulation of granulation. These effects can be determined in clinical studies, though the quality of the studies done so far and of the evidence of the usefulness of US is poor. Nevertheless, high-frequency and low-frequency US may be reasonable options in the management of chronic wounds.

Low level laser therapy in acute dehiscence saphenectomy: therapeutic proposal

Nathali Cordeiro Pinto,Physiotherapist; Post-Graduation Student of InCor/HC-FMUSP; Mara Helena Corso Pereira, Anesthesiologist Physician; Head of the Anesthesia Group of InCor/HC-FMUSP; Noedir Antônio Groppo Stolf, Cardiac Surgeon Physician; Titular Professor of the Discipline of Cardiovascular Surgery of InCor/HC-FMUSP; Maria Cristina Chavantes, Pneumologist Physician; Director of the Service of Laser Medical Center of InCor/HC-FMUSP. Rev Bras Cir Cardiovasc vol.24 no.1 São José do Rio Preto Jan./Mar. 2009. doi: 10.1590/S0102-76382009000100017 

Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy.

Effect of soft laser and bioactive glass on bone regeneration in the treatment of infra-bony defects (a clinical study)

Nayer S. AboElsaad, Mena Soory, Laila M. A. Gadalla, Laila I. Ragab, Stephen Dunne, Khaled R. Zalata and Chris Louca. Lasers in Medical Science, Volume 24, Number 3, 387-395, DOI: 10.1007/s10103-008-0576-9

This study aimed to investigate the influence of low-power 830 nm gallium–aluminium–arsenide (GaAlAs) laser [continuous wave (CW) 40 mW and fluence 4 J/cm2, with total energy density of 16 J/cm2] on the healing of human infra-bony defects treated with bioactive glass graft material. Twenty patients with chronic periodontitis and bilateral infra-bony defects were included. Using a split mouth design, we treated 20 defects with bioactive glass plus laser irradiation during surgical procedures and on days 3, 5, 7 postoperatively; 20 contra-lateral defects were treated with bioactive glass only. Clinical probing pocket depths, clinical attachment levels and standardized periapical radiographs were recorded at baseline and at 3 months and 6 months postoperatively. At 3 months there was a statistically significant difference between the laser and non-laser sites in the parameters investigated. However, at 6 months, no difference was observed. Our results have confirmed the positive effect of soft laser in accelerating periodontal wound healing.

Wound Healing of Animal and Human Body Sport and Traffic Accident Injuries Using Low-Level Laser Therapy Treatment: A Randomized Clinical Study of Seventy-Four Patients with Control Group

Zlatko Simunovic, Anthony D. Ivankovich, Arsen Depolo. Journal of Clinical Laser Medicine & Surgery. April 2000, 18(2): 67-73. doi:10.1089/clm.2000.18.67

Background and Objective: The main objective of current animal and clinical studies was to assess the efficacy of low level laser therapy (LLLT) on wound healing in rabbits and humans. Study Design/Materials and Methods: In the initial part of our research we conducted a randomized controlled animal study, where we evaluated the effects of laser irradiation on the healing of surgical wounds on rabbits. The manner of the application of LLLT on the human body are analogous to those of similar physiologic structure in animal tissue, therefore, this study was continued on humans. Clinical study was performed on 74 patients with injuries to the following anatomic locations: ankle and knee, bilaterally, Achilles tendon; epicondylus; shoulder; wrist; interphalangeal joints of hands, unilaterally. All patients had had surgical procedure prior to LLLT. Two types of laser devices were used: infrared diode laser (GaAlAs) 830 nm continuous wave for treatment of trigger points (TPs) and HeNe 632.8 nm combined with diode laser 904-nm pulsed wave for scanning procedure. Both were applied as monotherapy during current clinical study. The results were observed and measured according to the following clinical parameters: redness, heat, pain, swelling and loss of function, and finally postponed to statistical analysis via χ2 test. Results: After comparing the healing process between two groups of patients, we obtained the following results: wound healing was significantly accelerated (25%–35%) in the group of patients treated with LLLT. Pain relief and functional recovery of patients treated with LLLT were significantly improved comparing to untreated patients. Conclusion: In addition to accelerated wound healing, the main advantages of LLLT for postoperative sport- and traffic-related injuries include prevention of side effects of drugs, significantly accelerated functional recovery, earlier return to work, training and sport competition compared to the control group of patients, and cost benefit.