Effects of Photobiomodulation and Split-Thickness Skin Grafting in the Prognosis of Wound Healing in Children with Deep Burn Ulcers.

Background: Split-thickness skin grafting (STSG) is a standard therapeutic technique in patients with extensive and deep ulcers. Hospitalization and surgery can result in complications, especially in children. Photobiomodulation (PBM) has been applied in a variety of conditions such as healing of surgical, venous, pressure, and diabetic wounds, but no clinical trial using this method for healing of burn ulcers in children was found on searching the literature. The aim of the study was to evaluate the effect of PBM on the outcome of burn ulcers in children. Materials and methods: Informed consent and protocols were reviewed according to Shahid Beheshti University of Medical Sciences' Medical Ethics Board (IR.SBMU.REC.1394.363) and the Iranian Registry of Clinical Trials (IRCT2016011726069N1). Forty children with deep burn ulcers, who were candidates for STSG, were divided into PBM and STSG groups. A 650-nm laser (power 150 mW, spot size 0.6 cm2, time 10 sec, and energy point 1.5 J) was used for irradiation over the burn area every other day until complete healing in the PBM group. STSG was performed in the STSG group. All other therapeutic care protocols were identical. Results: Thirty-nine children completed the study. The mean ulcer size in the two groups was similar before treatment (PBM = 60.72 cm2 ± 13.8 and STSG = 63.74 ± 7.6). In the PBM group, all wounds healed within 10-12 sessions. Analysis of the burn area was performed 1, 3, and 6 months after injury. There was a significant difference (t test) in the burn area after 6 months in the PBM group compared with the STSG group (t test; p > 0.001). Conclusions: This is the first study to compare PBM and STSG in burn ulcers in children. Results indicated that PBM was an effective alternative to STSG, significantly decreasing the rate of scar and hypertrophic scar formation. Potential mechanisms of PBM that may be involved in burn tissue repair are discussed.

Effects of intravenous and transdermal photobiomodulation on the postoperative complications of coronary artery bypass grafting surgery: a randomized, controlled clinical trial.

Although coronary artery bypass graft (CABG) surgery is one of the most worldwide commonly performed cardiac surgeries to enhance myocardial perfusion in high-grade myocardial occlusion, it remains a high-risk procedure. Photobiomodulation (PBM) is one of the methods which have been shown to have positive effects on the healing process after CABG and postoperative complications. The aim of this study was to evaluate the efficacy of PBM in patients who underwent a coronary artery bypass graft (CABG). Ths study was conducted with 192 volunteers who electively submitted to CABG. The volunteers were randomly allocated into two groups: laser-treated (transdermal: 980 nm, 200 mW, continuous, average energy fluency of 6 J/cm2 and intravenous: 405 nm, 1.5 mW, continuous for 30 min) and standard treatment and control group (standard treatment only). Intravenous laser was illuminated the day before the surgery, immediately after transferring the patient to CCU post-operation and IV laser in addition to transdermal laser was applied every day after surgery for 6 days. A total of 170 out of 192 participants completed the study, 82 (48.2%) in the PBM group and 88 (51.8%) in the control group. Level of LDH and CPK was significantly lower in the PBM group (P < 0.05) in the 4th day postoperatively. The PBM group also showed significantly lower post-surgery complications, including pericardial effusion, ejection fraction, pathologic ST changes, pathologic Q, rehospitalization, heart failure, and mediastinitis (P < 0.05). Likewise, the VAS pain score after surgery was significantly lower in patients in the laser group (P < 0.05). PBM seems a promising, safe, cost-benefit therapeutic modality to reduce postoperative complications of CABG. Trial registration number: IRCT2016052926069N4 .

The Efficacy of Carbone Dioxide Laser Debridement Along With Low-Level Laser Therapy in Treatment of a Grade 3 Necrotic Burn Ulcer in a Paraplegic Patient (A Case Report).

Introduction: A deep burn ulcer, especially in areas with sensory-motor dysfunction, is hard to cure. Case Report: The patient was a 20-year-old paraplegic girl with a grade 3 necrotic burn ulcer for 3 weeks. We used a fractional Co2 laser along with chemical debridement with trichloroacetic acid (TCA 80%) and low-level laser therapy (LLLT) with a 808 nm infrared laser, 6 J/cm2 for the necrotic area, and a 650 nm red laser, 2 J/cm2 for the open wound area. Complete healing occurred after 25 sessions without surgery. Conclusion: Laser debridement along with LLLT and TCA administration may be useful to treat necrotic ulcers without surgery.

An Open-Label Study of Low-Level Laser Therapy Followed by Autologous Fibroblast Transplantation for Healing Grade 3 Burn Wounds in Diabetic Patients.

Introduction: Low-level laser therapy (LLLT) has been used as an effective therapeutic modality since the mid-1960s. Although there have been several clinical studies using LLLT in wound healing, especially diabetic, pressure and venous ulcers, there are few reports of using this technique in burn ulcers. Autologous fibroblast transplantation is a novel treatment for patients with burns or venous ulcers. In this study for the first time, we used LLLT along with autologous fibroblast skin transplantation to treat grade 3 burn ulcers in diabetic patients. This case series describes the successful management of grade 3 burn ulcers in 10 diabetic patients using autologous fibroblast transplantation along with LLLT. Methods: After the approval of the Tehran University Ethics Committee (IR.TUMS.REC.1394.1683) and the Iran Registry of Clinical Trials (IRCT2016050226069N3), 10 diabetic patients with 10 grade 3 burn ulcers, who were a candidate for skin graft surgery, entered the study. Donor skin was biopsied using a 3 mm punch. Fibroblasts were extracted and cultured in vitro in the GMP Technique laboratory. The patients were treated using LLLT in 3-4 weeks during the time that fibroblast cultures became ready to use. Laser irradiation was done using red light, 650 nm, 150 mW, 1 J/cm2 for the bed of the ulcer and infra-red light 808 nm, 200 mW, 6 J/cm2 for the margins every other day for 10 sessions. Results: The mean wound size before treatment was 16.28 cm2 . All patients' burn wounds healed completely after 10-12 weeks. Conclusion: We conclude that this method can be used as an effective method for treating large wounds, especially in complicated patients including the diabetics.

Evaluation of the Effects of Low Level Laser Therapy on the Healing Process After Skin Graft Surgery in Burned Patients (A Randomized Clinical Trial).

Introduction: Skin graft is the standard therapeutic technique in patients with deep ulcers, but like every surgical procedure, it may present some complications. Although several modern dressings are available to enhance comfort of donor site, the use of techniques that accelerate wound healing may enhance patient's satisfaction. Low level laser therapy (LLLT) has been used in several medical fields, especially for wound healing, but it may take several months for large ulcers treated with laser to heal completely. Methods: Nine patients with bilateral similar grade 3 burn ulcers in both hands or both feet were selected as candidates for split-thickness skin graft (STSG). One side was selected for laser irradiation and the other side as control, randomly. Laser was irradiated every day for 7 days with red 655 nm light, 150 mW, 2 J/cm2 at the bed of the ulcer and with infra-red 808 nm light, 200 mW for the margins. Results: The rate of wound dehiscence after skin graft surgery was significantly lower in laser treated group in comparison to control group which received only classic dressing (P=0.019). Conclusion: The results showed LLLT to be a safe effective method which improves graft survival and wound healing process and decreases the rate of wound dehiscence in patients with deep burn ulcers.

Clinical and Radiographic Alterations in Bilateral Avascular Necrosis of the Femoral Head Following Laser Acupuncture: A Case Report.

Introduction: Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability with unknown etiology. Traumatic and non-traumatic factors can be effective in its occurrence. About 50% of cases are bilateral. The underlying treatment is prosthetic replacement surgical procedure. Case Presentation: We report a case of bilateral AVN of femoral heads who was a candidate for prosthetic replacement surgery but improved significantly, using laser acupuncture. The patient was a 55-year-old woman with a diagnosis of bilateral osteonecrosis of the femoral head for five years. As the patient declined the surgical option, laser acupuncture was started for pain control. Regarding the signs of bilateral femoral head recovery (according to the MRI scan criteria), a total of 3 courses of laser acupuncture (each course was 20 sessions) with 2 months intervals was performed. Ten acupuncture points: Li4, Li11, St36, SP6, LIV3, GB4, GB5, GB6, GB13, GB14, GB20, GB30, GB31, GB34, were irradiated bilaterally using red 650 nm laser, 100 mW, 1505 Hz frequency, duty cycle 50 3 J/point and near infrared 810 nm laser, 100 mW, 1705 Hz frequency, duty cycle 50 3 J/point, for 2 minutes. The patient received 3 laser therapy courses. During the first-course, laser therapy was done every other day to reduce pain. For the second and third courses, according to pain decrease, therapy was done every week. Results: The results of the MRI scans and x-ray studies show progressive regeneration of the right femoral head from VI to B II and of the left from V to C II (based on the standard table of Pennsylvania). Conclusion: It seems that this procedure may be mentioned in future research projects, especially in cases with high risks of surgery.

Effect of low-level laser therapy on the healing process of donor site in patients with grade 3 burn ulcer after skin graft surgery (a randomized clinical trial).

Skin graft is a standard therapeutic technique in patients with deep ulcers, but managing donor site after grafting is very important. Although several modern dressings are available to enhance the comfort of donor site, using techniques that accelerate wound healing may enhance patient satisfaction. Low-level laser therapy (LLLT) has been used in several medical fields, including healing of diabetic, surgical, and pressure ulcers, but there is not any report of using this method for healing of donor site in burn patients. The protocols and informed consent were reviewed according to Medical Ethics Board of Shahid Beheshti University of Medical Sciences (IR.SBMU.REC.1394.363) and Iranian Registry of Clinical Trials (IRCT2016020226069N2). Eighteen donor sites in 11 patients with grade 3 burn ulcer were selected. Donor areas were divided into 2 parts, for laser irradiation and control randomly. Laser area was irradiated by a red, 655-nm laser light, 150 mW, 2 J/cm2, on days 0 (immediately after surgery), 3, 5, and 7. Dressing and other therapeutic care for both sites were the same. The patients and the person who analyzed the results were blinded. The size of donor site reduced in both groups during the 7-day study period (P < 0.01) and this reduction was significantly greater in the laser group (P = 0.01). In the present study, for the first time, we evaluate the effects of LLLT on the healing process of donor site in burn patients. The results showed that local irradiation of red laser accelerates wound healing process significantly.

Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.

Significant populations in burn centers are diabetic burn patients. Healing process in these patients is more difficult due to diabetes complications. The gold standard treatment for patients with grade 3 burn ulcer is split-thickness skin grafting (STSG), but in the diabetic patients, the rate of graft failure and amputation is high due to impaired tissue perfusion. The technique of low level laser therapy (LLLT) improves tissue perfusion and fibroblast proliferation, increases collagen synthesis, and accelerates wound healing. The purpose of this case report is introducing a new therapeutic method for accelerating healing with better prognosis in these patients. The protocols and informed consent were reviewed according to the Medical Ethics, Board of Shahid Beheshti Medical Sciences (IR.SBMU.RAM.REC.13940.363). Diabetic type 2 patients with 13 grade 3 burn ulcers, candidate for amputation, were enrolled in the study. We used a 650-nm red laser light, 2 J/Cm for the bed of the ulcer and an 810-nm infrared laser light 6 J/Cm(2) for the margins along with intravenous laser therapy with a 660-nm red light, before and after STSG for treating grade 3 burn ulcers in 13 diabetic ulcers. The results of this study showed complete healing in the last 8 weeks for all patients who were candidates for amputation. In this case series, we present 13 cases of diabetic ulcer with type 3 burn wound, candidate for amputation, who healed completely using LLLT and STSG. This is the first time that these two techniques are combined for treatment of burn ulcer in diabetic patients. Using LLLT with STSG might be a promising treatment for burn victims especially diabetic patients.