RESUMO
Necrosis is common in skin flap surgeries. Photobiomodulation, a noninvasive and effective technique, holds the potential to enhance microcirculation and neovascularization. As such, it has emerged as a viable approach for mitigating the occurrence of skin flap necrosis. The aim of this systematic review was to examine the scientific literature considering the use of photobiomodulation to increase skin-flap viability. The preferred reporting items for systematic reviews and meta-analyses (PRISMA), was used to conducted systematic literature search in the databases PubMed, SCOPUS, Elsevier and, Scielo on June 2023. Included studies investigated skin-flap necrosis employing PBMT irradiation as a treatment and, at least one quantitative measure of skin-flap necrosis in any animal model. Twenty-five studies were selected from 54 original articles that addressed PBMT with low-level laser (LLL) or light-emitting diode (LED) in agreement with the qualifying requirements. Laser parameters varied markedly across studies. In the selected studies, the low-level laser in the visible red spectrum was the most frequently utilized PBMT, although the LED PBMT showed a similar improvement in skin-flap necrosis. Ninety percent of the studies assessing the outcomes of the effects of PBMT reported smaller areas of necrosis in skin flap. Studies have consistently demonstrated the ability of PBMT to improve skin flap viability in animal models. Evidence suggests that PBMT, through enhancing angiogenesis, vascular density, mast cells, and VEGF, is an effective therapy for decrease necrotic tissue in skin flap surgery.
Assuntos
Terapia com Luz de Baixa Intensidade , Necrose , Retalhos Cirúrgicos , Animais , Terapia com Luz de Baixa Intensidade/métodos , Pele/efeitos da radiação , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguíneaRESUMO
Bothrops snake envenomation is characterized by severe local manifestations such as pain, edema, inflammation, hemorrhage, and myonecrosis. Furthermore, it is described that venom from juvenile and adult snakes may have differences in their composition that can lead to differences in the evolution of the clinical manifestation of the victim. Photobiomodulation (PBM) has been shown to be an effective adjuvant therapy to serum therapy to reduce the local effects induced by bothropic snake venom. This study evaluated the effect of PBM on the local reaction, after Bothrops alternatus snake venom (BaV) injection, in its juvenile (BaJV) and adult (BaAV) stages. Balb/C mice were injected with the juvenile or adult venoms of BaV or saline solution (control group). PBM at a wavelength of 660 nm, 100 mW, 0.33 W/cm2, 40 s, and a 0.028 cm2 beam was applied transcutaneous to a single point with a radiant exposure of 4 J/cm2, 30 min after venom injection. Edema, inflammatory infiltrate, hyperalgesia, and myonecrosis were analyzed. Both venoms induced significant edema and myonecrosis in the gastrocnemius muscle. Hyperalgesia in the mice paw and a prominent leukocyte infiltrate into the peritoneum were also observed. PBM significantly reduced all evaluated parameters. In conclusion, PBM treatment was effective in reducing the local effects induced by B. alternatus venom at different stages of snake development and could be a useful tool as an adjuvant treatment for bothropic envenomation.
Assuntos
Bothrops , Venenos de Crotalídeos , Terapia com Luz de Baixa Intensidade , Doenças Musculares , Camundongos , Animais , Venenos de Crotalídeos/toxicidade , Hiperalgesia , Venenos de Serpentes/toxicidade , Edema/induzido quimicamente , Edema/radioterapiaRESUMO
Bothrops snakebite treatment is antivenom therapy, which is ineffective in neutralizing the severe local effects caused by these envenomations. There are evidence that photobiomodulation therapy (PBMT) has emerged as a promising tool to counteract the venom-induced local effects. The purpose was to write a narrative review of the literature about PBMT as a treatment for Bothrops snakebites. We reviewed articles indexed in PubMed, SCOPUS and Scientif Direct database with filter application. Included studies had to investigate local effects induced by Bothrops snake venom in any animal model using any type of photobiomodulation irradiation and at least one quantitative measure of local effects of Bothrops envenomation. Sixteen studies were selected from 54 original articles targeted PBMT (low-level laser or light emitting diode) as a complementary tool for local effects treatment induced by snakebites, and all its assessments. Articles were critically assessed by two independent raters with a structured tool for rating the research quality. PBMT demonstrate to be a promising tool for local treatment effects caused by snakebite by reducing local edema, hyperalgesia, leukocyte influx and myonecrosis and accelerating tissue regeneration related to myotoxicity. However, the mechanism is not well understood and additional studies are needed.
Assuntos
Bothrops , Venenos de Crotalídeos/toxicidade , Terapia com Luz de Baixa Intensidade/métodos , Mordeduras de Serpentes/radioterapia , Animais , Antivenenos , Modelos Animais de Doenças , Músculo Esquelético/patologia , Músculo Esquelético/efeitos da radiação , Mordeduras de Serpentes/patologiaRESUMO
O sistema imune envolve diversos mecanismos de resposta imunológica que são fundamentais para o organismo se manter em equilíbrio e protegido. Dentre estes mecanismos, há a expressão de citocinas anti-inflamatórias e imunomoduladoras, como a interleucina-10 (IL-10). Esta citocina anti-inflamatória tem um papel crucial no sistema imune, uma vez que desempenha inúmeras funções biológicas. Estudos têm demonstrado que a terapia de fotobiomodulação (TFBM) tem sido eficaz na modulação da citocina IL-10, aumentando sua expressão, em várias doenças de caráter inflamatório. Apesar do mecanismo de ação da TFBM ainda não ser totalmente compreendido, esta vem se mostrando uma terapia promissora para estas doenças. Diante disso, o objetivo deste trabalho foi revisar estudos clínicos em que avaliaram a liberação/expressão da citocina IL-10 em diversas patologias em resposta à TFBM, e discutir as evidências atuais e potenciais da fotobiomodulação.
The immune system involves several immune response mechanisms that are essential for the body to remain in balance and protected. Among these mechanisms, there is the expression of anti-inflammatory and immunomodulatory cytokines, such as interleukin-10 (IL-10). This anti-inflammatory cytokine plays a crucial role in the immune system, since it performs numerous biological functions. Studies have shown that photobiomodulation therapy (PBMT) has been effective in modulating the cytokine IL-10, increasing its expression, in various diseases of an inflammatory character. Although the mechanism of action of PBMT is not yet fully understood, it has been shown to be a promising therapy for these diseases. Therefore, the objective of this work was to review clinical studies in which they evaluated the release / expression of the cytokine IL-10 in several pathologies in response to PBMT, and to discuss the current and potential evidences of photobiomodulation.