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Laser's healing touch
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Dr. J. RAJENDRAN on a unique case study of the rehabilitation of a cardiac patient using low-level laser therapy.
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MRS. N, 43, was admitted in hospital as a post-operative valve replacement patient. The cardiac surgery was done at another hospital. At the time of admission, she had developed multiple complaints, the most prominent being a deep burrowing bedsore in the sacral region that was graded as stage IV with infection. This combination posed a threat of developing into septicaemia and endocarditic. As her general health was poor, any surgical intervention could not be attempted. But a team of specialists (a cardiologist, plastic surgeon, infection control specialist and rehabilitation specialist) took charge and worked its way towards curing the illness and rehabilitating the patient.
A structured comprehensive rehabilitation programme was initiated. The chronic wound had secondary confounding conditions including infection and metabolic and nutritional disorders which made wound management more challenging. Along with this the team also faced the challenge of emotional distress in the patient adding to her physical disability.
The aim was to induce healing, to accelerate it and to prevent recurrence. Medicine is blessed to be in the current era of therapeutic intervention and enable a holistic approach to wound care with access to excellent dressing material, patient support systems and physical modalities to promote and enhance tissue repair.
Low Level Laser Therapy (LLLT) was employed and we were able to initiate the bio-stimulatory effect with minimal dose. Over a period of 24 days we obtained wound contraction (almost 60 per cent) and prepared the wound bed to be healthy and granulating. At this stage, the rehabilitation plan proved to be successful and the patient was found fit to undergo plastic surgery. A superficial skin graft procedure was performed.
Conclusion: Wound care, once a matter of trial and error, is on its way to becoming an exact science, and can be done well in a trained, motivated, multi-disciplinary setting using research tested equipment, dressing and drugs and techniques involving a well informed client.
A wound is defined as any disruption of the anatomical or functional continuity of tissue.
One of the most fundamental, and marvellous, defence properties of living organisms is the power to heal. We often tend to take the wound healing process for granted. However, it is very complex and can be influenced by many factors. Wound care is an art which has evolved into a specialised field. An understanding of physiologic responses to the wound will help us choose the appropriate dressing and physical modalities and ensure good healing, thus preventing morbidity.
A structured wound-healing programme includes thorough evaluation, cleaning and dressing and the use of physical modalities for enhanced healing.
Physical modalities in wound healing: These serve as transducers to provide physical forces to the wound, and help them to heal better and earlier.
One of the physical modalities used to treat the wounds is the laser.
The laser, which is an acronym for Light Amplification by Stimulated Emission of Radiation, is the outcome of intense research and development based on the concepts of laser/microwave amplification by stimulated emission of radiation. A laser is the generator of intense coherent, electromagnetic radiation in the spectral range between ultra violet and infrared wavelengths.
The laser can be classified based on its source, wavelength and output. Based on the output power, it is classified into class 1, class 2, class 3A, class 3B and class 4. Hard lasers are used by surgeons and soft lasers by physicians involved in wound healing.
Not all lasers are useful for bio-stimulation. A laser whose wavelength is more than 600 nm can be used for bio-stimulation. LLLT seems to be the best for wound and ulcer treatment. As early as 1967, Professor Endre Mesters and group at Seemel Weins Hospital in Budapest published the first scientific report concerning the effect of non-thermal laser light on the skin of rats.
LLLT accelerates cell division. There will be a marked increase in the number of leucocytes that participate in phagocytosis. The activity of fibroblast will be higher and collagen formation increases manifold. LLLT has been shown to enhance the rate and degree of vascularisation in growing tissue.
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