Laser Therapy for Wound Healing & Plastic Surgery Recovery
excerpt taken from Dr. Toshio Ohshiro's paper: "27 YEARS OF LASER TREATMENT: A PERSONAL PERSPECTIVE"
Plastic Surgical Applications of Laser Therapy
After the success of laser therapy in both the pain clinic and dermatology, I moved on more or less in parallel to a number of other indications. In plastic surgery I looked at a number of indications, including flap and graft problems and their solution; wound healing acceleration; control of severe ulcer formation; tissue welding and so on. Failing grafts and flaps due to vascular compromise are a major problem for the plastic surgeon and dermatologist.
Together with my colleague Dr Junichiro Kubota I started in the early and mid eighties-a series of rat experiments to assess the use of LLLT in promoting flap survival. (22) The findings proved that there was a laser-specific reaction in the laser therapy treated flaps compared with the untreated control and non-laser but same wavelength light irradiated animals. We found better earlier perfusion (Figure 24), better angiogenesis (Figure 25) and better flap survival (Figure 26) in the laser-treated group compared with the other two, but no difference between the untreated and non-laser treated group. Subsequent studies using laser speckle flowmetry have corroborated the earlier studies, and clinical experience has borne out the experimental data.(23,24)
Figure 27, courtesy of Dr Yu Maruyama, shows LLLT (830 nm, cw, 60 mW, contact method) saving a necrotic flap following free flap formation to repair a major defect left after a traffic accident. The progress of the revascularization of the flap can be seen, together with the final result. Hematoma formation is a major problem in skin grafting, as the hematoma prevents the take between the graft and the wound bed. Dr Kioizumi presented a series of clinical findings of LLLT in the restoration of failing skin grafts of which Figure 28 is a representative example.(18) Concomitantly he showed in experimental studies(25) that LLLT had a number of important reactions on hematoma. The levels of prostaglandin E12 were significantly increased, which is an antiagregant for platelets. In addition the increased blood and lymphatic flow in the irradiated area significantly increased the presence of nutrients, scavenger cells and neovascularization, while at the same time increasing the levels of lysing agents for the fibrin mesh holding the hematoma together.
The earlier work of Dr Lisa Schindl on LLLT and Buerger's disease, thromboangiitis obliterans,(27) prompted us to start our own work. Figure 29 shows the typical ulcerous destruction of the big toe in an early stage Buerger's patient before and 15 months after 830 nm diode laser therapy. The patient was also in extreme pain, another feature of this disease, and the patient's pain was also totally removed. Figure 30 shows the pre- and post-LLLT plain angiographic findings in the same patient in the affected limb at the femoral artery level. The neoangiogenesic budding and branching is clearly demonstrated, weeks after the first LLLT session, which is the basis of the long-term effectiveness of LLLT in this otherwise incurable progressive and possibly fatal disease. Dr Schindl's follow-up periods are currently well over nine years for her early patients, with no recurrence. Despite our best efforts and instructions, patients will occasionally not practice the correct wound care procedure following surgical treatment. With conventional or lasers, therapy. Unpleasant sequelae occur, such as ulceration, as seen in the patient in Figure 31, taken from my earlier experience. I first used the defocused Nd:YAG on the lesions, with minor success, but with the appearance of the 830 nm diode laser, the improvement was rapid and complete. Other authors have also published a series on the use of LLLT for control and healing of postoperative ulcerations.(19)
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