Photobiomodulation, as additional treatment to traditional dressing of hard-to-heal venous leg ulcers, in frail elderly with municipality home healthcare.

The main objectives of the study were to explore whether laser Photobiomodulation (PBM) in addition to traditional dressing of hard-to-heal venous leg ulcer, reduced healing time of the ulcer and if the duration of the ulcer before PBM impacted the treatment time with PBM to healing. The intervention group was frail, elderly patients with home healthcare in the municipality of Skellefteå, registered in the Swedish quality registry RiksSar for ulcer treatment with hard-to-heal venous leg ulcer. The control group with equivalent physical conditions was obtained from the same quality registry. Definition of hard-to-heal ulcer was six weeks duration or more. The PBM was performed two times per week with laser type infrared GaAs, 904nm, 60mW, and 700Hz, targeting lymphatic area and ulcer area. Laser type red visible, GaAllnp, 635nm, 75mW and 250Hz, targeting ulcer area. The intervention group treated with PBM in addition to traditional dressing healed significantly faster than the control group with a mean of 123 days (p = 0.0001). Duration of the ulcer before PBM did not impact the healing time. To conclude, the findings indicate that using PBM in addition to dressing may have multiple benefits on hard-to-heal venous leg ulcer, saving valuable time and resources for patients, healthcare providers, and institutions.

Effectiveness of Blue light photobiomodulation therapy in the treatment of chronic wounds. Results of the Blue Light for Ulcer Reduction (B.L.U.R.) Study.

BACKGROUND: Lower limb ulcers not responding to standard treatments after 8 weeks are defined as chronic wounds, and they are a significant medical problem. Blue light (410-430 nm) proved to be effective in treating wounds, but there is a lack of data on chronic wounds in clinical practice. The aim of the study was to determine if blue light photobiomodulation with EmoLED (Emoled Srl, Sesto Fiorentino, Florence, Italy) medical device in addition to standard of care is more effective compared to standard of care alone in promoting re-epithelialization of chronic wounds of lower limbs in 10 weeks. METHODS: Ninety patients affected by multiple or large area ulcers were enrolled. To minimize all variabilities, each patient has been used as control of himself. Primary endpoint was the comparison of the re-epithelialization rate expressed as a percentage of the difference between the initial and final area. Secondary endpoints were: treatment safety, pain reduction, wound area reduction trend over time, healing rate. RESULTS: At week 10, the wounds treated with EmoLED in addition to standard care showed a smaller residual wound area compared to the wounds treated with standard of care alone: 42.1% vs. 63.4% (P=0.029). The difference is particularly evident in venous leg ulcers, 33.3% vs. 60.1% (P=0.007). 17 treated wounds and 12 controls showed complete healing at week 10. Patients showed a significant reduction in pain (P=2×10-7). CONCLUSIONS: Blue light treatment in addition to standard of care accelerates consistently the re-epithelialization rate of chronic wounds, especially venous leg ulcers and increases the chances of total wound healing in 10 weeks.

Low Intensity Shockwave Treatment Modulates Macrophage Functions Beneficial to Healing Chronic Wounds.

Extracorporeal Shock Wave Therapy (ESWT) is used clinically in various disorders including chronic wounds for its pro-angiogenic, proliferative, and anti-inflammatory effects. However, the underlying cellular and molecular mechanisms driving therapeutic effects are not well characterized. Macrophages play a key role in all aspects of healing and their dysfunction results in failure to resolve chronic wounds. We investigated the role of ESWT on macrophage activity in chronic wound punch biopsies from patients with non-healing venous ulcers prior to, and two weeks post-ESWT, and in macrophage cultures treated with clinical shockwave intensities (150-500 impulses, 5 Hz, 0.1 mJ/mm2). Using wound area measurements and histological/immunohistochemical analysis of wound biopsies, we show ESWT enhanced healing of chronic ulcers associated with improved wound angiogenesis (CD31 staining), significantly decreased CD68-positive macrophages per biopsy area and generally increased macrophage activation. Shockwave treatment of macrophages in culture significantly boosted uptake of apoptotic cells, healing-associated cytokine and growth factor gene expressions and modulated macrophage morphology suggestive of macrophage activation, all of which contribute to wound resolution. Macrophage ERK activity was enhanced, suggesting one mechanotransduction pathway driving events. Collectively, these in vitro and in vivo findings reveal shockwaves as important regulators of macrophage functions linked with wound healing. This immunomodulation represents an underappreciated role of clinically applied shockwaves, which could be exploited for other macrophage-mediated disorders.

Low-level laser therapy for treatment of venous ulcers evaluated with the Nursing Outcome Classification: study protocol for a randomized controlled trial.

BACKGROUND: Different methods are available for the treatment of venous ulcers. Most current approaches focus on a combination of topical and compressive therapy. Adjuvant low-level laser therapy may be helpful in lesions with a protracted healing course, but evidence for its use is still limited. This paper describes the protocol of a randomized controlled trial designed to compare the effect of adjuvant low-level laser therapy versus conventional venous ulcer tissue repair, evaluated by a nurse using clinical indicators from the Nursing Outcomes Classification (NOC). METHODS/DESIGN: For this prospective randomized controlled trial, 40 adult patients of both sexes with active venous ulcers will be recruited. Subjects will be selected by the sealed-envelope method without any annotation or external identification that might refer to the type of study group. At the time of unblinding, a label with the description of the group to which the patient belongs (that is, control or intervention) will be found inside the envelope. Conventional treatment (topical medication and compressive therapy) will be offered to both groups. Additionally, the intervention group will receive adjuvant low-level laser therapy. All patients will be followed weekly until ulcer healing or for a maximum of 16 weeks. Evaluation of tissue repair will be based on 14 clinical indicators drawn from NOC for wound healing (secondary intention) and tissue integrity (skin and mucous membranes). The primary endpoint will be decreased wound size and scar formation. This laser therapy is expected to enhance the quality, speed, and effectiveness of the treatment of venous ulcers, a chronic condition. This should reduce associated costs to the health service and allow patients to resume their daily activities sooner. DISCUSSION: This randomized clinical trial will use a validated method to investigate the effect of a novel intervention for the treatment of venous ulcers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03229330 . Registered on July 2017.

Laser irradiation effect on Staphylococcus aureus and Pseudomonas aeruginosa biofilms isolated from venous leg ulcer.

Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous leg ulcers, represent a significant cause of morbidity in developed countries, predominantly in older patients. The aetiology of these wounds is probably multifactorial, but the role of bacteria in their pathogenesis is still unclear. Moreover, the presence of bacterial biofilms has been considered an important factor responsible for wounds chronicity. We aimed to investigate the laser action as a possible biofilm eradicating strategy, in order to attempt an additional treatment to antibiotic therapy to improve wound healing. In this work, the effect of near-infrared (NIR) laser was evaluated on mono and polymicrobial biofilms produced by two pathogenic bacterial strains, Staphylococcus aureus PECHA10 and Pseudomonas aeruginosa PECHA9, both isolated from a chronic venous leg ulcer. Laser effect was assessed by biomass measurement, colony forming unit count and cell viability assay. It was shown that the laser treatment has not affected the biofilms biomass neither the cell viability, although a small disruptive action was observed in the structure of all biofilms tested. A reduction on cell growth was observed in S. aureus and in polymicrobial biofilms. This work represents an initial in vitro approach to study the influence of NIR laser treatment on bacterial biofilms in order to explain its potentially advantageous effects in the healing process of chronic infected wounds.

A prospective randomized study of 980 nm diode laser-assisted venous ulcer healing on 34 patients.

Venous ulcers are chronic wounds affecting up to 1% of adults in developed countries. Considering that noncontact normothermic therapy has been shown to modify the wound healing process, we conducted a prospective comparative clinical trial aimed at evaluating 980 nm diode laser in laser-assisted venous ulcer healing. Thirty-four Caucasian patients with venous leg ulcers were included in the study and separated into two homogenous groups based on age, sex ratio, size, and etiologies of the ulcers. In the laser group, 980 nm InGasAs diode laser (power 15 W, spot size 8 mm, time 3 seconds, fluence 90 J/cm(2) ) was applied weekly for 9 weeks to the ulcers in a homogenous standardized manner, resulting in a local temperature of 45-50 °C, which was controlled with a thermal infrared camera. Complete healing, reduction in size, and pain during and between each procedure were evaluated each time. Of the 18 patients in the laser group, three (16.7%) were completely healed during laser treatment. In the control group (16 patients), the healing was complete for four patients (25%). This difference was not significant (p=0.62). At the ninth follow-up visit, in the control group, the ulcers had decreased on an average to 94.3% of the original area of the ulcers. In the laser group, the decrease was to 74.2% of the original area of the ulcers. Again, this difference was not significant (p=0.60). The mean VAS score between each treatment was 2.7 (0.5-4.4) in the laser group compared with 3.8 (2.3-5.0) in the control group (0.13

Electromagnetic therapy for treating venous leg ulcers.

BACKGROUND: Leg ulceration is a common, chronic, recurring condition. The estimated prevalence of leg ulcers in the UK population is 1.5 to 3 per 1000. Venous ulcers (also called stasis, or varicose ulcers) comprise 80 to 85% of all leg ulcers. Electromagnetic therapy is sometimes used as a treatment to assist the healing of chronic wounds such as venous leg ulcers. OBJECTIVES: To assess the effects of electromagnetic therapy on the healing of venous leg ulcers. SEARCH STRATEGY: For this first review update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy or other treatments. DATA COLLECTION AND ANALYSIS: For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. A second reviewer checked data extraction. Meta-analysis was applied to combine the results of trials where the interventions and outcome measures were adequately similar. For this first update, two reviewers independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. In the case of disagreements, a final decision was made either after discussion between two reviewers or consultation with a third party (a member of the Cochrane Wounds Group). MAIN RESULTS: This update identified no new trials. A total of three eligible RCTs were identified by the original review. Two trials compared the use of electromagnetic therapy with sham therapy and one trial compared it with standard topical treatments. One trial found a difference in healing rates of borderline statistical significance between electromagnetic therapy and sham therapy, although the direction of treatment effect was consistently in favour of electromagnetic therapy, the difference was not statistically significant. AUTHORS' CONCLUSIONS: There is currently no reliable evidence of benefit of electromagnetic therapy in the healing of venous leg ulcers. Further research is needed.

[Venous leg ulcers: no improvement of wound healing with 685-nm low level laser therapy. Randomised, placebo-controlled, double-blind study]. / Ulcus cruris venosum: Keine Verbesserung der Wundheilung durch Anwendung eines 685-nm-Low-Level-Lasers Randomisierte, placebokontrollierte, doppelblinde Studie.

INTRODUCTION: Venous leg ulcers (ulcera crurum venosa) are frequently seen in elderly patients. It has been suggested that low level laser irradiation has a biostimulative and wound healing effect; however, this has not yet been clinically verified by controlled studies. STUDY DESIGN: The difference in size reduction of leg ulcers with and without low level laser or placebo laser treatment was measured in 44 patients randomised into two treatment groups (685-nm low level laser and placebo laser) or a control group which served to quantify the effect of laser application. All patients received standardized wound care. OBJECTIVE: The aim of the study was to compare the effectiveness of low level laser irradiation with that of a placebo "light source". The size of the ulcers was planimetrically measured at baseline (day 1), at the end of therapy (day 28) and 2 months later (day 90). The difference in wound size was evaluated. RESULTS: There were no statistically significant differences in reduction of wound size between the three groups, thus suggesting that low level laser light does not have any stimulatory effect on wound healing in ulcera crurum venosa.

Does low output laser stimulation enhance the healing of crural ulceration? Some critical remarks.

The objective of the experiment was to evaluate the impact of laser stimulation on crural ulceration healing. Three groups were established at random from patients with crural ulceration: A, B and C. Group A included 21 patients, group B included 22 patients and group C, 22 patients. Patients in all groups were treated with pharmaceuticals and with compressive therapy. The ulcers in group A were additionally irradiated with laser light of wavelength 810 nm, so that a dose of 4 J/cm2 was applied in each procedure. Patients in group B were additionally subjected to a blind test (with placebo in the form of quasi-laser therapy). At the end of the treatment a statistically significant reduction of the area and volume of the ulcers was found in all groups. No statistically significant difference was found between the groups in terms of average rate of change per week of the relative area of ulceration and average rate of change per week of the relative volume of ulceration. Reduction of infected area was observed in all groups, but a significant change was only observed in group C. No significant impact of laser light (lambda=810 nm, P=65 mW, p=4 J/cm2) on any of the stages of ulceration healing was observed.

Utilización de laserpuntura en úlceras de miembros inferiores / Laserpuntura use in ulcers of inferior members

Se exponen los resultados obtenidos con el empleo de la laserpuntura a un total de 21 casos remitidos por el Servicio de Angiología con el diagnóstico de úlceras de tipo flebotónicas y postraumáticas al Hospital General "Ciro Redondo"de Artemisa. La información sobre los pacientes se registró en un documento confeccionado al efecto. En la investigación se usó un modelo de grupo único, lineal, y se les aplicó a las tablas el cálculo de X2, así como el valor promedio. Los resultados que se obtuvieron fueron de 95,2 por ciento de mejoría y cura de las lesiones y el 90 por ciento de confianza en afirmar que las úlceras de causa traumática evolucionan de manera favorable y más rápida que las de causa venosa, y reafirman la ventaja de esta modalidad de tratamiento(AU)

The results obtained using laser-puncture in a total of 21 cases referred to the Angiology Service of "Ciro Redondo" General Hospital, in Artemisa province, are shown. Information on patients was registered in a document designed for that purpose. In research, we used a form of linear unique group and the X2 estimate and the average value were applied to the tables. It was obtained 95.2 percent of improvement and cure of lesions and 90 percent of confidence on guaranteeing that the ulcers of traumatic origin evolve in a favorable way and more quickly than those of venous origin, which reaffirms the advantages of this treatment modality(AU)

Electromagnetic therapy for the treatment of venous leg ulcers.

BACKGROUND: Electromagnetic therapy is used with the aim of improving the healing of chronic wounds such as pressure sores and venous leg ulcers OBJECTIVES: To assess the effectiveness of electromagnetic therapy in the treatment of venous leg ulcers SEARCH STRATEGY: The Cochrane Wounds group search strategy was used (see Scope) to search for randomised controlled trials (RCTs) of electromagnetic therapy for the treatment of venous leg ulcers SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy or other (standard) treatment DATA COLLECTION AND ANALYSIS: Results of searches were scrutinised by one reviewer (and checked by a second) to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second reviewer. MAIN RESULTS: A total of three eligible RCTs were identified. Two trials compared the use of electromagnetic therapy to sham (Ieran 1990; Kenkre 1996) and one trial (Stiller 1992) compared it with standard topical treatments. One of the trials found a difference in healing rates of borderline statistical significance between electromagnetic therapy and sham, although the direction of treatment effect was consistently in favour of electromagnetic therapy the difference was not statistically significant. REVIEWER'S CONCLUSIONS: There is currently no reliable evidence of benefit of electromagnetic therapy in the healing of venous leg ulcers.

[Laser's biostimulation in healing or crural ulcerations]. / Biostymulacja laserowa w leczeniu owrzodzen zylnych goleni.

The objective of this paper was to evaluate effect of laser's biostimulation on the process of healing of crural ulcerations. Three comparative groups of patients, A, B and C, were made at random from the patients with venous crural ulcerations. The group A consisted of 17, the group B 15, the group C 17 patients. The patients in all comparative groups were treated pharmacologically and got compress therapy. Ulcerations at patients in group A were additionally irradiated by light of biostimulation's laser (810 nm) in this way that every time ulcerations got dose of energy 4 J/cm2. The patient's in-group B additionally got blind trial (with placebo in the form of quasi-laserotherapy). The evaluated factors were to estimate how laser's biostimulation causes any changes of the size of the ulcers and of the volume of tissue defect. The speed of changes of size and volume of tissue defect per week was calculated. After the treatment there was statistically significant decrease of size of ulcers in all comparative groups while there was no statistically significant difference between the groups observed. After the treatment there was statistically significant decrease of volume of ulcers only in groups A and C but there was no statistically significant difference between the groups observed.

Low power laser therapy and analgesic action.

OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. METHODS: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.

[LILAB, a new system for superficial application of low intensity laser beams in medicine]. / LILAB, ein neues System zur flächendeckenden Applikation von gebündelten Laserstrahlen geringer Intensität in der Medizin.

Laser energy densities between 1 and 4 J/cm2 evoked a significant biostimulation in human tissues. Lower energy densities had no apparent effect, but higher energy densities resulted in cell damage. In principle, low energy densities can be applied with high-energy lasers in combination with laser beam diverging lenses, or with low-power lasers in combination with scanning devices. High-energy lasers are undesirable because of their high cost. Low-energy lasers in combination with conventional scanners also suffer from high cost, and these scanners have another major disadvantage: the energy density at the edge of the application field may be up to five times as great as in the center. A new laser beam distribution system for medical applications is introduced here. Because of its moderate price it is well-suited for use with low-energy lasers. Any desired geometrical shape of the application field is easily created, and with a homogeneous energy density.

[Treatment of trophic ulcers of the lower extremities using a magnetic field]. / Lechenie troficheskikh iazv nizhnikh konechnostei s ispol'zovaniem magnitnogo polia.

The experience with treatment of 126 patients with ulcerous-necrotic lesion of the lower extremities of different genesis was summarized. A comparative evaluation of the effectiveness of treatment depending on a type of the magnetic field: the constant, alternating, or travelling impulse one was carried out. The most effective was the use of a travelling impulse magnetic field. The results of the investigation performed give grounds to recommend the wide use of magnetotherapy in the complex treatment of trophic ulcers of the lower extremities.

Effect of low power gallium arsenide laser on healing of venous ulcers.

The healing of venous ulcers of the leg with and without gallium arsenide laser treatment was studied in 42 patients randomly divided into two groups. One group received standard conservative treatment and gallium arsenide laser, and the other received the same standard treatment and placebo laser treatment. There were no differences in results between the two groups.

Morphology of epithelizing varicose ulcers following He-Ne laser therapy.

The present study is a report on the morphological, particularly ultrastructural findings in the newly formed epidermis of varicose ulcerations after a series of irradiations with a low energy He-Ne laser. The ultrastructural alterations are interpreted as most probably conditioned by the biostimulating effect of the radiation and they are compared with the results obtained by other investigators studying these problems and with findings in the epithelium of embryonal epidermis as well as in the epidermis exposed to ultraviolet radiation.

[Treatment of non-healing wounds and trophic ulcers by low- intensity laser irradiation in an outpatient clinic]. / Lechenie dlitel'no ne zazhivaiushchikh ran i troficheskikh iazv nizkointensivnym lazernym izlucheniem v usloviiakh polikliniki.

Experience in treating 351 patients with persistent wounds and trophic ulcers by low-intensity laser radiation in out-patient clinics is generalized. Complete epithelialization of the wound or ulcer surface occurred in 236 patients. There were 246 patients aged 60, all were treated without leave from work. Thus, the inclusion of laser therapy in the complex of measures for persistent wounds and trophic ulcers is a highly effective method which may be applied in preoperative management and which will reduce considerably the term of in-patient treatment.