Bedsore Revitalization By LLLT, Low Level Laser Therapy (Level Laser: LED-Ga-Al- As,660 nm)

4. 4
 Allied health professionals regularly
care for a variety of skin wounds, such
as abrasions, turf burns, surgical
incisions, and ulcerations, which are
perhaps the most difficult to treat.
From acute wound management to
augmentation of scar tissue
remodeling, the clinician seeks to
optimize wound care to promote
healing.

5. 5
• Experimental in vitro and in vivo
studies have been under development
since the 1960s, and in the early 1990s,
LLLT was approved by the Food and
Drug Administration (FDA) as an
important method for treating healing
processes.2-4
• Recent results of a study
demonstrated that LLLT is an effective
method to modulate tissue repair, thus
significantly contributing to a faster and
more organized healing process.5

6.  Low level laser acts (biostimulative
light energy effect) on biological
tissues at cellular level. Absorbed laser
energy causes stimulation of molecules
and atoms of cells, followed by-
 Stimulates cell activation processes
which in turn, intensify physiological
activities.
6

7. Enhancement of
SOFT Tissue Healing.
Although there are no magical ways
to heal soft tissue wound, but there
are ways to help speed up the
healing process, and help debilitated
patient to recover earlier/ faster.
• Proper medical management of the
wound.
• Proper management of systemic
diseases.
• Proper Nursing.
• Nutritional Support.
• Stem Cell therapy/ Gene-therapy.
• Ultrasound therapy.
• Low Level Laser therapy.

8. The beneficial effect of LLLT on wound healing
can be explained by considering several basic
biological mechanisms :
Firstly, there is a report [48] that laser increases
both protein and mRNA levels of IL-1α and IL-8
in keratinocytes. These are cytokines
responsible for the initial inflammatory phase
of wound healing.
Secondly, there are reports [49] that LLLT can
upregulate cytokines responsible for fibroblast
proliferation, and migration such as bFGF,
HGF and SCF.
Thirdly ,it has been reported [50] that LLLT can
increase growth factors such as VEGF
responsible for the neovascularization
necessary for wound healing.

9. Fourthly, TGF-β is a growth factor
responsible for inducing collagen synthesis
from fibroblasts and has been reported to be
upregulated by LLLT [51].
Fifthly ,
There are reports [52, 53] that LLLT can induce
fibroblasts to undergo the transformation
into myofibloblasts, a cell type that expresses
smooth muscle α-actin and desmin and has
the phenotype of contractile cells that
hasten wound contraction.

10. The primary (physical) mechanisms
relate to the interaction between
photons and molecules in the tissue,
while the secondary mechanisms
relate to the effect of the chemical
(Bio-chemical) changes induced by
primary effects.
10
Laser mechanism of Action
on biological tissues can be
explained by-
1. Physical mechanism
2. Bio-chemical mechanism

11. Physical -
There are two primary forms of
physical effects generated by
laser irradiation on biological
tissues:
 Photon-absorption ( the basis of
photobiological action, and
generated by all forms of light).
 Internal conversion &
fluorescence of light also
generates Speckle formation,
which is unique to laser therapy.
11
Mechanism
of action Of LLLT on
tissue-

12. “Action of Laser/Light photon
with mitochondrial respiratory chain
– Cytochromecoxidase enzyme”.
 Cytochromecoxidase mediated
increase
in ATP production.
 Cytochromecoxidase mediated singlet-
oxygen production.
 Cytochromecoxidase mediated
Reactive oxygen species (ROS)
formation.
 Cytochromecoxidase mediated
Photodiassociation and Nitric Oxide
Production.
12
Biochemical -
Mechanism
of action Of LLLT on tissue-

13. 13
Low Level Laser
Increases -
 Cellular ion-exchange,
 Tissue vascularization,
 Lymphatic circulation,
 Fibroblast,
And Activates -
 Cytokines,
 Growth factors and
 Necessary hormonal activities for
tissue healing enhancement in the
proliferative stage thereby reduction
of pain & inflammation.
Mechanism
of action Of LLLT on tissue-

14. Current Issue

15. 15
Materials & Method
Place of study:

16.  Duration of study:
The duration of this study was
one year (from Jan.- 2010 to
Dec.- 2010.
 Type of study:
 Prospective Randomized Case
Control study.
Materials & Method

17. Materials: sample
Patient:
 Bedsore/ Decubitus Ulcer
Patients.
 A total of 10 patients randomly
collected.
 The sample was collected randomly
from admitted patients with
Bedsore in the back older than 12
weeks which has not cured by all
means of available conventional
medical management.
17
Materials & Method

18. 1. Patient suffering from bedsore more
than 12 weeks.
2. Failed to heal by all means of
conventional therapy.
3. Male and Female ratio- 50:50.
4. Age between 55- 95 years old,
5. Hasn’t previously treated with
LLLT.
Selection Criteria-
Inclusion Criteria :
Materials & Method

19. The patients were briefed
about the study and
written consent (Informed
consent) was obtained
from all patients/ medico-
legal guardian for other
patients.
Medico-legal
Informed Consent:
Selection Criteria-
Materials & Method

20. • Machine: BioLux MD
LLLT, Low Level Laser
(LED- Ga-Al- As 660).
•Irradiance Parameters
LED Apparatus: BioLux MD
 Beam source -
Incoherent-Ga-Al-As.
o Mode: Continuous wave
o Irradiance dose: 4- 8 J/cm2/min.
o Irradiance time: 1- 2 minutes
o Wavelengths Used: 660 nm.
o Total session: 25-35.
Bio-Lux MD Ga- Al-
As Laser
( 660 nm ) Machine.
Materials & Method

21. Method:
21
Ten (10) patients with bedsore
(on the back) were selected for
placebo-controlled, double-blind
study using low energy photon
therapy (LLLT).
Treatment was given three times
a week for 10 weeks, using
monochromatic (red) optical
sources; diode 660nm (GaAl-
660).
Materials & Method

22. Method:
22
The patients who were
randomized to placebo
treatment received sham
therapy from an identical-
appearing light source from
the same delivery system.
Materials & Method

23. Method:
23
TABLE -1
Approach and methodology
week
Frequenc
y
Wound
Area/size
Irradiation
Source Wave
Energy
Fluency
Poin
t
Time
1-2 week 5/ week 6.8 cm2 LED-660 nm (Ga-
Al-As)
Contin
uous
6 joules/cm2 2 8 joules/min.
3-5 week 3/ week 5.7 cm2 LED-660 nm (Ga-
Al-As)
Contin
uous
4 joules/cm2 2 8 joules/min.
4-6 week 3/ week 4.4 cm2 LED-660 nm (Ga-
Al-As)
Contin
uous
4 joules/cm2 1 8 joules/min.
7-8 week 2/week 2.2 cm2 LED-660 nm (Ga-
Al-As)
Contin
uous
3 joules/cm2 1 8 joules/min.
9-10 week 2/ week Closed LED-660 nm (Ga-
Al-As)
Contin
uous
3 joules/cm2 1 8 joules/min.
Treatment Protocol/ Schedule
(Dose, duration and wound parameter)
Materials & Method

24. 1. Subjective assessment:
Physical Assessment: Assessment done
by doing comparison of wound healing
treated by laser therapy to regular
stages of wound healing by natural
process.
a. Colour
b. Vascularity
c. Margin
d. Depthness of wound.
2. Objective assessment:
Clinical assessment by -
a. Function of the affected area.
b. Mobility of the treated side.
c. Patient Compliance.
24
Efficacies
of treatment
were evaluated
by-
Materials
& Method

25. 25
Visualization of treatment
Progress by
LLLT (LED-Ga-Al-As 660 nm)
of a patient -
Chronological Picture
View of
a Laser(LLLT) Treated
Patient.
1st,2nd,3rd week)
4th,5th,6th week)
7th,8th,week)
9th,10th,11th,12th week)

26. In this study, the percentage of
the initial ulcer area remaining
unhealed in the LLLT and placebo
groups was 24.4% and 84.7%,
respectively (P = 0.0008).
The decrease in ulcer area
(compared to baseline) observed
in the LLLT and placebo groups
was 193.0 mm2 and 14.7 mm2,
respectively (P = 0.0002).
26

27. 27
TABLE -2
Morphology of the Wounds Before and After Therapy-
Wound Before debridement After debridement/ closure
Wound parameters-  Prior to
Therapy
 End of
Therapy
 Prior to
Therapy
 End of
Therapy
1.  Margin Irregular &
indurated
Partially Regular
Sutured In tacked skin
2.  Floor Unhealthy,
Necrotic Oozing
Tissue
Almost Healthy
granulation tissue Covered Covered
3.  Base Spine bone
Exposed
Partially Clear
granulation tissue
Spine
bone covered Covered
4  Surrounding skin Inflamed and
scared
Partially Healthy Healthy Up to
mark Healthy
5.  Discharge Profuse purulent
Oozing pus
Serous Discharge
No discharge No discharge

28. 28
Low-level laser therapy is an important
method for the treatment of healing
processes, and several experimental
studies have been carried out in search
of a greater understanding of its
therapeutic possibilities.
The objective of this study was to review
pathogenetic aspects of soft tissue repair
to better understand skin lesion healing
and the role of low-intensity laser in the
progression of tissue healing.

29. 29
In the past Laser / LED were shown
to be effective in wound
management but in different
degrees, some of those applications
showed significant improvement.
This study results efficacy of LLLT on
wound healing in human model, and
indicates that it can be a very
important adjunctive tool /modality
for chronic intractable wound
management, and in any way it is
not harmful to human being.

30. The result of this study reveals a
better Bedsore Healing by diode
laser (Ga-Al-As).
This study result also concludes
that better healing after irradiation
with Ga-Al-As, 660nm diode laser
in human model as an adjunctive
to regular medical management
that accelerates soft tissue wound
healing significantly and enhances
patient compliances.

31. This study has demonstrated
the potential of low level laser therapy
in the treatment of –
“ Enhancement
Of
Human Bedsore
Healing”.
In conjunction to Regular
Management.
31

32. A large multi- centric study
pointing important
 Subjective i.e.
Mechanical,
Biochemical And
Histological As Well As
 Objective
Clinical Parameters.
32

33. Including -
 laser protocol (dose, duration, type
of laser & mode of operation),
 patient selection criteria and
 procedure of therapy,
is highly desirable to make this
non-invasive and very effective
method of bedsore healing
available in medical science. 33

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