Skin Grafts

Lasers Med Sci. 2018 Jan 24. doi: 10.1007/s10103-017-2430-4. [Epub ahead of print]

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).

Vaghardoost R1, Momeni M2, Kazemikhoo N3, Mokmeli S4, Dahmardehei M1, Ansari F5, Nilforoushzadeh MA3, Sabr Joo P1, Mey Abadi S1, Naderi Gharagheshlagh S1, Sassani S6.

Author information

1
Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran.
2
Burn Research center, Department of Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran. mah_momeni@yahoo.com.
3
Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
4
Canadian Optic and Laser Center, Victoria, BC, Canada.
5
Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
6
Al Nasr Sport Club Medical Section, Dubai, United Arab Emirates.

Abstract

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.

KEYWORDS:

Low-level laser therapy; Skin graft; Wound healing

Lasers Med Sci. 2017 Apr;32(3):641-648. doi: 10.1007/s10103-017-2160-7. Epub 2017 Feb 2.

Photobiomodulation laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

Leite GP1, das Neves LM1, Silva CA2, Guirro RR1, de Souza TR1, de Souza AK1, Garcia SB3, Guirro EC4,5.

Author information

1
Post-Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School-FMRP/USP, Ribeirão Preto, Brazil.
2
Post-Graduate Program in Human Movement Sciences, Methodist University of Piracicaba-UNIMEP, Piracicaba, Brazil.
3
Post-Graduate Program in Pathology, Ribeirao Preto Medical School-FMRP/USP, Ribeirão Preto, Brazil.
4
Post-Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School-FMRP/USP, Ribeirão Preto, Brazil. ecguirro@fmrp.usp.br.
5
Ribeirão Preto Medical School of the University of São Paulo (USP), Bandeirantes Avenue, 3900, Ribeirão Preto, SP, 14049-900, Brazil. ecguirro@fmrp.usp.br.

Abstract

The purpose of this study is to investigate the effect of pulsed electrical field (PEF) and photobiomodulation laser (PBM) on the viability of the TRAM flap in diabetic rats. Fifty Wistar rats were divided into five homogeneous groups: Group 1-control; Group 2-diabetics; Group 3-diabetics + PEF; Group 4-diabetic + laser 660 nm, 10 J/cm2, 0.27 J; Group 5-diabetic + laser 660 nm, 140 J/cm2, 3.9 J. The percentage of necrotic area was evaluated using software Image J®. The peripheral circulation of the flap was evaluated by infrared thermography FLIR T450sc (FLIR® Systems-Oregon USA). The thickness of the epidermis (haematoxylin-eosin), mast cell (toluidine blue), leukocytes, vascular endothelial growth factor, fibroblast and newly formed blood vessels were evaluated. For the statistical analysis, the Kruskal-Wallis test was applied followed by Dunn and ANOVA test followed by Tukey with critical level of 5% (p?<?0.05). The PEF reduced the area of necrosis, decreased the leukocytes, increased the mast cells, increased the thickness of epidermis and increased newly formed blood vessels when it was compared to the untreated diabetic group of animals. Laser 660 nm, fluence 140 J/cm2 (3.9 J) showed better results than the 10 J/cm2(0.27 J) related to reduction of the area of necrosis and the number of leukocytes, increased mast cells, increased thickness of the epidermis, increased vascular endothelial growth factor, increased fibroblast growth factor and increase of newly formed blood vessels in diabetic animals. The laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

KEYWORDS:

Diabetes mellitus; Dosimetry; Fibroblast growth factor; Lowlevel laser therapy; Phototherapy; Physiotherapy; Vascular endothelial growth factor

Lasers Med Sci. 2017 Feb;32(2):335-341. doi: 10.1007/s10103-016-2118-1. Epub 2016 Dec 2.

Laser photobiomodulation (830 and 660 nm) in mast cells, VEGF, FGF, and CD34 of the musculocutaneous flap in rats submitted to nicotine.

das Neves LM1, Leite GP2, Marcolino AM2, Pinfildi CE3, Garcia SB4, de Araújo JE1, Guirro EC5.

Author information

1
Post-Graduate Program in Rehabilitation and Functional Performance of Ribeirão Preto Medical School of the University of São Paulo (FMRP/USP), Av. dos Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
2
Post-Graduate Program in Rehabilitation Sciences, Federal University of Santa Catarina – Campus Araranguá – UFSC/SC, Florianópolis, Brazil.
3
Post-Graduate Program in Interdisciplinary Health Sciences, Federal University of Sao Paulo – Santos Campus – UNIFESP/SP, Sao Paulo, Brazil.
4
Post-Graduate Program in Pathology, Ribeirão Preto Medical School – FMRP/USP, Sao Paulo, Brazil.
5
Post-Graduate Program in Rehabilitation and Functional Performance of Ribeirão Preto Medical School of the University of São Paulo (FMRP/USP), Av. dos Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil. ecguirro@fmrp.usp.br.

Abstract

The aim of this study was to investigate the effect of laser photobiomodulation (PBM) on the viability of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats subjected to the action of nicotine. We evaluated 60 albino Wistar rats, divided into six groups of ten animals. Group 1 (saline) underwent the surgical technique to obtain a TRAM flap; group 2 (laser 830 nm) underwent the surgical technique and was irradiated with a laser 830 nm; group 3 (laser 660 nm) underwent the surgical technique and was irradiated with a laser 660 nm; group 4 was treated with nicotine subcutaneously (2 mg/kg/2×/day/4 weeks) and underwent surgery; group 5 (nicotine?+?laser 830 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 830 nm; group 6 (nicotine?+?laser 660 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 660 nm. The application of PBM occurred immediately after surgery and on the two following days. The percentage of necrosis was assessed using the AxioVision® software. The number of mast cells (toluidine blue staining) was evaluated, and immunohistochemistry was performed to detect vascular endothelial growth factor expression (anti-VEGF-A), fibroblasts (anti-basic FGF), and neoformed vessels (anti-CD34). PBM with a wavelength of 830 nm increased the viability of the TRAM flap, with a smaller area of necrosis, increased number of mast cells, and higher expression of VEGF and CD34. PBM increases the viability of musculocutaneous flaps treated with to nicotine.

Lasers Med Sci. 2016 Apr;31(3):497-502. doi: 10.1007/s10103-016-1896-9. Epub 2016 Feb 11.

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

Dahmardehei M1, Kazemikhoo N2, Vaghardoost R1, Mokmeli S3, Momeni M1, Nilforoushzadeh MA4,5, Ansari F4, Amirkhani A4.

Author information

1
Burn Research Center, Iran University of Medical Sciences, Tehran, Iran.
2
Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran. nooshakazemi@gmail.com.
3
Canadian Optic and Laser Center, Victoria, BC, Canada.
4
Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
5
Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

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.

KEYWORDS:

Burn wound; Low level laser therapy; Skin transplantation

Plast Surg (Oakv). 2015 Spring;23(1):35-9.

Inhibitory effects of low-level laser therapy on skin-flap survival in a rat model.

Baldan CS1, Masson IF1, Esteves Júnior I1, Baldan AM1, Machado AF1, Casaroto RA1, Liebano RE1.

Author information

1
Paulista University, São Paulo, Brazil.

Abstract

in English, French

BACKGROUND:

Although several studies have demonstrated the effects of low-level laser therapy (LLLT) on skin flap viability, the role of higher doses has been poorly investigated.

OBJECTIVE:

To investigate the inhibitory effect of the LLLT (?=670 nm) on the viability of random skin flaps in a rat model using an irradiation energy of 2.79 J at each point.

METHODS:

Sixteen Wistar rats were randomly assigned into two groups: sham laser irradiation (n=8); and active laser irradiation (n=8). Animals in the active laser irradiation group were irradiated with a 670 nm diode laser with an energy of 2.79 J/point, a power output 30 mW, a beam area of 0.028 cm(2), an energy density of 100 J/cm(2), an irradiance of 1.07 W/cm(2) for 93 s/point. Irradiation was performed in 12 points in the cranial skin flap portion. The total energy irradiated on the tissue was 33.48 J. The necrotic area was evaluated on postoperative day 7.

RESULTS:

The sham laser irradiation group presented a mean (± SD) necrotic area of 47.96±3.81%, whereas the active laser irradiation group presented 62.24±7.28%. There was a significant difference in skin-flap necrosis areas between groups (P=0.0002).

CONCLUSION:

LLLT (?=670 nm) increased the necrotic area of random skin flaps in rats when irradiated with an energy of 2.79 J (100 J/cm(2)).

KEYWORDS:

Low-level laser therapy; Necrosis; Rats; Surgical flaps

Minerva Stomatol. 2014 Mar;63(3):77-83.

Histological assessment of nonablative laser stimulation of tissue repair in acellular dermal grafts.

Silveira V1, Cenci R, Oliveira M, Moraes J, Etges A, Zerbinatti L.

Author information

1
Oral and maxillofacial Department Pontifícia Universidade do Rio Grande do Sul (PUCRS) Porto Alegre, RS, Brazil – gerhardtoliveira@gmail.com.

Abstract

AIM:

The objective of this study was to compare integration of AlloDerm® acellular dermal grafts in animals subjected to non-ablative laserirradiation and animals not exposed to this therapy.

METHODS:

Standardized AlloDerm® fragments measuring 5 mm² were grafted into the subcutaneous tissue overlying the calvaria in 32 Wistar rats. Laser therapy (685 nm), at a dose of 4 J/cm2 per session, was applied immediately after surgical intervention and every 48 hours thereafter for a total of four applications.

RESULTS:

Analysis of histology slides revealed significantly greater edema in the control group. There was no neutrophil infiltration in the laser-irradiated group at any point during the study period, whereas such infiltration was present in control animals at three of the four points of observation. In the laser therapy group, lymphocyte infiltration was observed from day 1, whereas in the control group, it was only apparent from day 3. Vascularization was substantially greater in the control group. In the experimental group, the AlloDerm® graft was completely replaced by fibrous tissue.

CONCLUSION:

These findings suggest that add-on non-ablative laser therapy is an effective stimulator of healing and graft integration after placement of AlloDerm® acellular dermal grafts.

Lasers Med Sci. 2013 May;28(3):755-61. doi: 10.1007/s10103-012-1130-3. Epub 2012 Jun 22.

What is better in TRAM flap survival: LLLT single or multi-irradiation?

Pinfildi CE1, Hochman BS, Nishioka MA, Sheliga TR, Neves MA, Liebano RE, Ferreira LM.

Author information

1
Department of Science of Human Movement, University Federal of São Paulo-UNIFESP, Campus Baixada Santista, Santos, São Paulo, Brazil. cepinfildi@hotmail.com

Abstract

Lowlevel laser therapy (LLLT) has been used with the aim of improving vascular perfusion of the skin and musculocutaneous flaps. This study evaluated the effect of LLLT on transverse rectus abdominis musculocutaneous flap (TRAM) viability, vascular angiogenesis, and VEGF release. Eighty-four Wistar rats were randomly divided into seven groups with 12 rats in each group. Group 1 received sham lasertreatment; group 2, 3 J/cm(2) at 1 point; group 3, 3 J/cm(2) at 24 points; group 4, 72 J/cm(2) at 1 point; group 5, 6 J/cm(2) at 1 point; group 6, 6 J/cm(2) at 24 points; and group 7, 144 J/cm(2) at 1 point. All experimental groups underwent LLLT immediately after the TRAM operation and on the following 2 days; thus, animals underwent 3 days of treatment. The percentage of skin flap necrosis area was calculated on the fourth postoperative day using the paper template method, and two skin samples were collected using a 1-cm(2) punch to evaluate alpha smooth muscle actin (1A4) and VEGF levels in blood vessels. Significant differences were found in necrosis percentage, and higher values were seen in group 1 than in the other groups. Statistically significant differences were not found among groups 3 to 7 (p<0.292). Groups 5 and 7 showed significantly higher VEGF levels compared to other groups. Groups 3 and 5 had an increase in levels of blood vessels compared to other groups. LLLT at energy densities of 6 to 144 J/cm(2) was efficient to increase angiogenesis and VEGF levels and promote viability in TRAM flaps in rats.

Rev Col Bras Cir. 2013 Jan-Feb;40(1):44-8.

Macro and microscopic analysis of island skin grafts after lowlevel laser therapy.

[Article in English, Portuguese]
da Silva EB1, Maniscalco CL, Ésper GV, Guerra RR, Kerppers II.

Author information

1
Department of Agricultural and Environmental Sciences, State University of Santa Cruz – UESC, Ilheus, Bahia State – BA, Brazil. elisangelavet@yahoo.com.br

Abstract

OBJECTIVE:

To observe the effects of low intensity laser therapy in inflammation, wound healing and epithelialization of island skin grafts.

METHODS:

Twenty rats were subjected to this grafting technique and divided subsequently into two equal groups, one treated with laser and the other control.

RESULTS:

there was less inflammation, faster healing, epithelialization and keratinization in the laser-treated animals when compared to the untreated.

CONCLUSION:

Low intensity laser therapy is helpful to island skin grafting.

Lasers Med Sci. 2012 Sep;27(5):1045-50. doi: 10.1007/s10103-011-1042-7. Epub 2011 Dec 30.

LED (660 nm) and laser (670 nm) use on skin flap viability: angiogenesis and mast cells on transition line.

Nishioka MA1, Pinfildi CE, Sheliga TR, Arias VE, Gomes HC, Ferreira LM.

Author information

1
Post Graduation Plastic Surgery, Federal University of São Paulo, R. Napoleão de Barros, 715, 4º andar, CEP 04024-900, São Paulo, SP, Brazil.

Abstract

Skin flap procedures are commonly used in plastic surgery. Failures can follow, leading to the necrosis of the flap. Therefore, many studies use LLLT to improve flap viability. Currently, the LED has been introduced as an alternative to LLLT. The objective of this study was to evaluate the effect of LLLT and LED on the viability of random skin flaps in rats. Forty-eight rats were divided into four groups, and a random skin flap (10?×?4 cm) was performed in all animals. Group 1 was the sham group; group 2 was submitted to LLLT 660 nm, 0.14 J; group 3 with LED 630 nm, 2.49 J, and group 4 with LLLT 660 nm, with 2.49 J. Irradiation was applied after surgery and repeated on the four subsequent days. On the 7th postoperative day, the percentage of flap necrosis was calculated and skin samples were collected from the viable area and from the transition line of the flap to evaluate blood vessels and mast cells. The percentage of necrosis was significantly lower in groups 3 and 4 compared to groups 1 and 2. Concerning blood vessels and mast cell numbers, only the animals in group 3 showed significant increase compared to group 1 in the skin sample of the transition line. LED and LLLT with the same total energies were effective in increasing viability of random skin flaps. LED was more effective in increasing the number of mast cells and blood vessels in the transition line of random skin flaps.

Acta Cir Bras. 2012 Feb;27(2):155-61.

The effects of different doses of 670 nm diode laser on skin flap survival in rats.

Baldan CS1, Marques AP, Schiavinato AM, Casarotto RA.

Author information

1
Physical Therapy Department, UNIP and Sao Paulo Metodista University, Brazil. cristianobaldan@yahoo.com.br

Abstract

PURPOSE:

To investigate the effects of different low-level laser therapy (LLLT) doses on random skin flap rats.

METHODS:

Forty Wistar rats were randomly divided in four groups. The control group (CG) was not irradiated. The experimental groups were irradiated with a diode laser 670 nm with different energies per point: group 2 (G2) with 0.06 J; group 3 (G3) 0.15 J and group 4 (G4) 0.57 J. The three groups were irradiated in 12 equally distributed points in the cranial skin flap portion. They were submitted to the irradiation during the immediate, first and second postoperative days. The necrosis area was evaluated in the seventh postoperative day.

RESULTS:

The CG shows 49.35% of necrosis area in the skin flap; G2, 39.14%; G3, 47.01% and G4, 29.17% respectively. There was a significantly difference when G4 was compared with CG`s skin flap necrosis area.

CONCLUSION:

The low-level laser therapy diode 670 nm with 0.57 J energy per point increases the survival in randomic skin flap rats.

Photomed Laser Surg. 2010 Aug;28(4):483-8. doi: 10.1089/pho.2009.2500.

Influence of the use of laser phototherapy (lambda660 or 790 nm) on the survival of cutaneous flaps on diabetic rats.

Santos NR1, dos Santos JN, dos Reis JA Jr, Oliveira PC, de Sousa AP, de Carvalho CM, Soares LG, Marques AM, Pinheiro AL.

Author information

1
School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil.

Abstract

OBJECTIVE:

The aim of this study was to assess and compare the effects of laser phototherapy (LPT) on cutaneous flaps on diabetic rats.

BACKGROUND:

Diabetes mellitus is characterized by high blood glucose levels. Its main complications are delayed wound healing, an impaired blood supply, and a decrease in collagen production. Cutaneous flaps are routinely used in several surgical procedures, and most failures are related to poor blood supply. LPT has been studied using several healing models.

ANIMALS AND METHODS:

Twelve Wistar rats were randomized into three groups: group 1 (G1; diabetic animals without treatment), group 2 (G2; diabetic animals irradiated with lambda680 nm), and group 3 (G3; diabetic animals irradiated with lambda790 nm). Diabetes was induced with streptozotocin. A 2- x 8-cm cutaneous flap was raised on the dorsum of each animal, and a plastic sheet was introduced between the flap and the bed to cause poor blood supply. Nonirradiated animals acted as controls. The dose per session was 40 J/cm(2). Laser light was applied transcutaneously and fractioned on 16 contact points at the wound margins (16 x 2.5 J/cm(2)). Animal death occurred on day 8 after surgery. Specimens were taken, processed, cut, stained with eosin (HE) and sirius red, and underwent histological analysis.

RESULTS:

It is shown that accute inflammation was mostly discrete for G3. Chronic inflammation was more evident for G2. Fibroblast number was higher for G3. Angiogenesis was more evident for G3. Necrosis was more evident for G2. Statistical analysis among all groups showed significant differences (p = 0.04) on the level of acute inflammation between G1 and G3, tissue necrosis between G1 and G2 (p = 0.03), chronic inflammation between (p = 0.04), fibroblastic proliferation between G2 and G3 (p = 0.05), and neovascularization between G2 and G3 (p = 0.04).

CONCLUSION:

LPT was effective in increasing angiogenesis as seen on irradiated subjects and was more pronounced when IR laser light was used.

Photomed Laser Surg. 2010 Jun;28(3):379-84. doi: 10.1089/pho.2009.2535.

Effect of low-level laser therapy on malondialdehyde concentration in random cutaneous flap viability.

Prado R1, Neves L, Marcolino A, Ribeiro T, Pinfildi C, Ferreira L, Thomazini J, Piccinato C.

Author information

1
Department of Surgery and Anatomy, University of São Paulo-FMRP-USP, Ribeirão Preto, Brazil. paschoalrp@hotmail.com

Abstract

OBJECTIVE:

The aim of this study was to assess the effects of 830 and 670 nm laser on malondialdehyde (MDA) concentration in random skin-flap survival.

BACKGROUND DATA:

Low-level laser therapy (LLLT) has been reported to be successful in stimulating the formation of new blood vessels and activating superoxide-dismutase delivery, thus helping the inhibition of free-radical action and consequently reducing necrosis.

MATERIALS AND METHODS:

Thirty Wistar rats were used and divided into three groups, with 10 rats in each one. A random skin flap was raised on the dorsum of each animal. Group 1 was the control group; group 2 received 830 nm laser radiation; and group 3 was submitted to 670 nm laser radiation. The animals underwent laser therapy with 36 J/cm(2) energy density immediately after surgery and on the 4 days subsequent to surgery. The application site of the laser radiation was 1 point, 2.5 cm from the flap’s cranial base. The percentage of the skin-flap necrosis area was calculated 7 days postoperative using the paper-template method, and a skin sample was collected immediately after as a way of determining the MDA concentration.

RESULTS:

Statistically significant differences were found between the necrosis percentages, with higher values seen in group 1 compared with groups 2 and 3. Groups 2 and 3 did not present statistically significant differences (p > 0.05). Group 3 had a lower concentration of MDA values compared to the control group (p < 0.05).

CONCLUSION:

LLLT was effective in increasing the random skin-flap viability in rats, and the 670 nm laser was efficient in reducing the MDA concentration.

Photomed Laser Surg. 2009 Jun;27(3):411-6. doi: 10.1089/pho.2008.2320.

Effect of application site of low-level laser therapy in random cutaneous flap viability in rats.

Prado RP1, Pinfildi CE, Liebano RE, Hochman BS, Ferreira LM.

Author information

1
Master of Basic Sciences in Plastic Surgery, São Paulo Federal University, São Paulo, SP, Brazil. paschoalrp@hotmail.com

Abstract

OBJECTIVE:

This study aimed to investigate the effect of diode laser (830 nm) irradiation on the viability of ischemic random skin flaps in rats, as well as to determine the most effective site for applying laser radiation to speed healing.

BACKGROUND DATA:

Low-level laser therapy (LLLT) has recently been used to improve the viability of ischemic random skin flaps in rats.

MATERIALS AND METHODS:

Seventy Wistar rats were used and divided into seven groups of 10 rats each: group 1, sham laser treatment; group 2, which received irradiation at 1 point 5 cm from the flap’s cranial base; group 3, which received irradiation at 2 points (5 and 7.5 cm from the flap’s base); group 4, which received irradiation at 3 points (2.5, 5 and 7.5 cm from the flap’s base); group 5, which received irradiation at 1 point 2.5 cm from the flap’s base; group 6, which received irradiation at 2 points (2.5 and 5 cm from the flap’s base); and group 7, which received irradiation at 1 point 7.5 cm from the flap’s base. The animals were subjected to laser therapy at an energy density of 36 J/cm(2) for 72 sec immediately after surgery, and one time on each of the four subsequent days. The percentage of necrotic skin flap area was calculated on the seventh postoperative day using a paper template.

RESULTS:

The results showed that the rats in group 5 had the highest increase in skin flap viability, with a statistically significant difference compared to the other groups. Statistically significant differences were not seen between any of the other groups.

CONCLUSION:

The diode laser was effective in increasing skin flap viability in rats, and laser irradiation of a point 2.5 cm from the cranial base flap was found to be the most effective.

Photomed Laser Surg. 2009 Apr;27(2):337-43. doi: 10.1089/pho.2008.2295.

Effect of low-level laser therapy on mast cells in viability of the transverse rectus abdominis musculocutaneous flap.

Pinfildi CE1, Liebano RE, Hochman BS, Enokihara MM, Lippert R, Gobbato RC, Ferreira LM.

Author information

1
Department of Plastic Surgery and IMES-FAFICA, São Paulo Federal University, São Paulo, SP, Brazil. cepinfildi@hotmail.com

Abstract

OBJECTIVE:

To assess the effect of low-level laser therapy (LLLT) on viability of mast cells of the transverse rectus abdominis musculocutaneous (TRAM) flap.

BACKGROUND DATA:

LLLT has been recently used on the TRAM flap to stimulate mast cells.

MATERIALS AND METHODS:

Eighty-four Wistar rats were randomly divided into seven groups of 12 rats in each: group 1 (sham laser therapy); group 2 received 3 J/cm(2) at one point; group 3 received 3 J/cm(2) at 24 points; group 4 received 72 J/cm(2) at 1 point; group 5 received 6 J/cm(2) at 1 point; group 6 received 6 J/cm(2) at 24 points; and group 7 received 144 J/cm(2) at 1 point. All experimental groups underwent LLLT immediately after TRAM surgery and on the next two following days, for three sessions in total. The percentage of the area of skin flap necrosis was calculated on the fourth postoperative day and two samples of skin were collected from each rat with a 1-cm(2) punch to perform mast cell evaluations with toluidine blue dye.

RESULTS:

Statistically significant differences were found in the percentage of necrosis, and higher values were seen in group 1 than in all other groups. Among groups 3-7 no statistically significant differences were found (p < 0.292). For mast cells, when group 1 was compared to groups 5 (6 J/cm(2) at 1 point) and 7 (144 J/cm(2) at 1 point), it had fewer mast cells.

CONCLUSION:

LLLT at a wavelength of 670 nm was effective at reducing the necrotic area, and we found that it can stimulate mast cells growth to increase vascular perfusion.

Ann Plast Surg. 1985 Mar;14(3):278-83.

Effects of low-power diode lasers on flap survival.

Kami T, Yoshimura Y, Nakajima T, Ohshiro T, Fujino T.

Abstract

We investigated the effect of low-power laser irradiation on the survival of experimental skin flaps in rats. A gallium-aluminum-arsenide diode laser that was developed by the Japan Medical Laser Laboratory was used. The laser power was 15 mW and the wavelength 830 nm. Irradiation was carried out, either before or after flap elevation, in two groups of 20 Wistar strain rats. A third group of 20 rats served as controls. A caudally based skin flap, 3 X 9 cm, was designed on the back of each rat. Laser irradiation therapy was performed for 5 consecutive days for 6 minutes per flap per day, preoperatively in one group and postoperatively in the other. Seven days postoperatively, the survival areas of the flaps were measured and compared. The survival area was increased significantly in both groups receiving laser therapy, probably due to the observed proliferation of blood vessels around the irradiated points and an increase in blood flow.

PMID:
3994272

Avascular Necrosis of Femoral Head

Act Ortop Mex.  2013 Jul-Aug;27(4):265-72.

[Review of non-surgical treatment of avascular necrosis of the femoral head].

[Article in Spanish]
Gómez-García F.

Abstract

Avascular necrosis of the femoral head is a frequent condition with an insidious presentation; it is initially asymptomatic and thus it is seldom diagnosed at the early stages. The purpose of this review is to update the status of the diagnosis and non-surgical treatment of avascular necrosis of the femoral head. This paper analyzes the natural history of the disease as well as the prognostic importance of early diagnosis and the identification of the extension and location of osteonecrosis. It also discusses the different nonsurgical treatment methods such as: high energy extracorporeal shock waves, electromagnetic pulsed fields, hyperbaric oxygen therapy, drugs, physical therapy, and regenerative medicine. The conclusion is that no method is effective in the advanced stages and there is great hope of treating this condition without surgery; however, progress needs to be made in research, particularly in the use of external biophysical agents and regenerative medicine. The gold standard of treatment is still surgical decompression of the femoral head at the stages in which no collapse has occurred. The prognosis apparently improves with the use of biophysical and regenerative medicine adjuvants.

BMC Musculoskeletal Dirsord.  2011 Sep 29;12:215. doi: 10.1186/1471-2474-12-215.

Pulsed electromagnetic fields stimulation prevents steroid-induced osteonecrosis in rats.

Ding S1, Peng H, Fang HS, Zhou JL, Wang Z.
  • 1Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China.

Abstract

BACKGROUND:

Pulsed electromagnetic fields (PEMF) stimulation has been used successfully to treat nonunion fractures and femoral headosteonecrosis, but relatively little is known about its effects on preventing steroid-induced osteonecrosis. The purpose of the study was to investigate the effects of PEMF stimulation on the prevention of steroid-induced osteonecrosis in rats and explore the underlying mechanisms.

METHODS:

Seventy-two male adult Wistar rats were divided into three groups and treated as follows. (1) PEMF stimulation group (PEMF group, n = 24): intravenously injected with lipopolysaccharide (LPS, 10 g/kg) on day 0 and intramuscularly injected with methylprednisolone acetate (MPSL, 20 mg/kg) on days 1, 2 and 3, then subjected to PEMF stimulation 4 h per day for 1 to 8 weeks. (2) Methylprednisolone-treated group (MPSL group, n = 24): injected the same dose of LPS and MPSL as the PEMF group but without exposure to PEMF. (3) Control group (PS group, n = 24): injected 0.9% saline in the same mode at the same time points. The incidence of osteonecrosis, serum lipid levels and the mRNA and protein expression of transforming growth factor 1 (TGF-1) in the proximal femur were measured 1, 2, 4 and 8 weeks after the last MPSL (or saline) injection.

RESULTS:

The incidence of osteonecrosis in the PEMF group (29%) was significantly lower than that observed in the MPSL group (75%), while no osteonecrosis was observed in the PS group. The serum lipid levels were significantly lower in the PEMF and PS groups than in the MPSL group. Compared with the MPSL and PS groups, the mRNA expression of TGF-1 increased, reaching a peak 1 week after PEMF treatment, and remained high for 4 weeks, then declined at 8 weeks, whereas the protein expression of TGF-1 increased, reaching a peak at 2 weeks after PEMF treatment, and remained high for 8 weeks.

CONCLUSIONS:

PEMF stimulation can prevent steroid-induced osteonecrosis in rats, and the underlying mechanisms involve decreased serum lipid levels and increased expression of TGF-1.

Hip Int. 2011 Jul-Aug;21(4):385-92. doi: 10.5301/HIP.2011.8538.

Medical management of osteonecrosis of the hip: a review.

  • 1The Centre for Hip Surgery, Wrightington Hospital, Wigan, Lancashire, UK. asimrajpura@gmail.com

Abstract

Osteonecrosis or avascular necrosis (AVN) of the hip is a progressive disease mainly affecting adults in their third, fourth or fifth decade of life. Studies into the natural history of the disease suggest that femoral head collapse occurs within 2-3 yrs with associated degenerative changes and at that stage arthroplasty is the most reliable treatment option. Therefore prevention of femoral head collapse is highly desirable in this young patient group. In early stage disease, before femoral head collapse (Ficat and Arlet stage 1-3) core decompression of the femoral head is currently the most widely used procedure to try to relieve intraosseous pressure in the femoral head and restore blood supply.Greater understanding of the pathogenesis of osteonecrosis has led to research into non-surgical management of early stages of the disease, including pharmacological and biophysical treatments.There may be a reduction in symptoms and evidence of prevention of disease progression following some non-surgical treatments. Further studies are needed, including trials comparing medical management with surgical intervention.

Zhongguo Gu Shang.  2010 Jan;23(1):12-5.

[Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH)].

[Article in Chinese]
Kong FR1, Liang YJ, Qin SG, Li JJ, Li XL.
  • 1Department of Radiology and Nuclear Medicine, General Hospital of Fengfeng Co. Ltd, Handan 056200, Hebei, China. kongfr999@sina.com

Abstract

OBJECTIVE:

To investigate the application value of extracorporeal shock wave to repair and reconstruct osseous tissue for the treatment of avascular necrosis of the femoral head (ANFH).

METHODS:

A total of 42 hips of 36 patients with ANFH were treated with extracorporeal shock waves included 29 males and 7 females,aged from 21 to 66 during March 2006 to March 2008. The course of disease was 6 months to 3 years (means 1.3 years). According to Ficat classification 8 hips were in stages I, 25 were in stage II, and 9 were in stage III. The energy density of ESWT was from 0.18 to 0.25 mJ/mm2. The treatment focusing points of avascular necrosis of the femoral on the surface projection were marked with X-ray fluoroscopy, and 1 to 2 points were selected for one treatment with 400 to 500 pulses in each point. Generally 3 to 5 treatments were performed, once per 7 days. The CR, CT or MRI and the hip Harris score were obtained to investigate the clinical effects of extracorporeal shock wave for repair and reconstruct osseous tissue framework and improve the hip function before treatment and at 3, 12 months after treatment.

RESULTS:

The X-ray,CT or MR were performed of 42 hips,35 hips were treated successfully after extracorporeal shock wave therapy, cure occurred in 6 cases, marked effect in 13 cases, effectiveness in 16 cases and ineffectiveness in 7 case. After one years of followed-up, no relapse was found, the femoral head further collapse did not occur. The Harris hip score of stage I, II, III ere respectivey (90.1 +/- .4), (81.2 +/- .5), (66.9 +/- .6) at 3 months and (91.6 +/- .4), (91.1 +/- .5), (79.0 +/- .1) at 12 months after treatment. The scores after treatment were increased significantly than that of before treatment (P < 0.01).

CONCLUSION:

Extracorporeal shock wave therapy has obviously therapeutic effect in the repairing and reconstructing osseous tissue and improve the hip Harris score and improve the hip function. It is a effect significantly, non-invasion, less complications, simple-accurate therapy method for ischemic necrosis of the femoral head.

Indian J Orthop.  2009 Jan;43(1):17-21. doi: 10.4103/0019-5413.45319.

Biophysical stimulation in osteonecrosis of the femoral head.

Leo M, Milena F, Ruggero C, Stefania S, Giancarlo T.

Abstract

Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs) has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary.

J Bone Joint Surg Am.  2006 Nov;88 Suppl 3:56-60.

Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head.

Massari L1, Fini M, Cadossi R, Setti S, Traina GC.
  • 1Department of Biomedical Sciences and Advanced Therapies, Orthopaedic Clinic, University of Ferrara, Corso della Giovecca, 44100 Ferrara, Italy. msl@unife.it

Abstract

BACKGROUND:

Osteonecrosis of the femoral head is the end point of a disease process that results in bone necrosis, joint edema, and cartilage damage. It leads to joint arthritis that necessitates total hip arthroplasty in many patients. Because of its positive effects on osteogenesis and its chondroprotective effect of articular cartilage, pulsed electromagnetic field stimulation has been proposed as a method to prevent or delay the progression of osteonecrosis.

METHODS:

A retrospective analysis of the results of treatment with pulsed electromagnetic field stimulation of seventy-six hips in sixty-six patients with osteonecrosis of the femoral head was performed. Patients with Ficat stage I, II, or III osteonecrosis of the femoral head were treated with pulsed electromagnetic field stimulation for eight hours per day for an average of five months. Clinical and diagnostic imaging information was collected at the start of the treatment and at the time of follow-up. The primary end point analyzed was the avoidance of hip surgery, and the secondary end point was limiting the radiographic progression (according to Ficat stage) of osteonecrosis of the femoral head.

RESULTS:

Fifteen hips required a total hip arthroplasty; twelve of these hips were in patients with Ficat stage-III disease. The need for total hip arthroplasty was significantly higher in patients with Ficat stage-III disease than in patients with Ficat stage-I (p < 0.0001) or II (p < 0.01) disease at the beginning of treatment. Pulsed electromagnetic fields preserved 94% of Ficat stage-I or II hips. Furthermore, radiographic progression (according to Ficat stage) occurred in twenty hips (26%). Pain, present in all patients at the start of the treatment, disappeared after sixty days of stimulation in thirty-five patients (53%) and was of moderate intensity in seventeen patients (26%).

CONCLUSIONS:

The results of this study confirm that pulsed electromagnetic field treatment may be indicated in the early stages of osteonecrosis of the femoral head (Ficat stages I and II). Pulsed electromagnetic field stimulation may be able to either preserve the hip or delay the time until surgery. The authors hypothesize that the short-term effect of pulsed electromagnetic field stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of pulsed electromagnetic field stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Orthopade.  2000 May;29(5):403-10.

[Osteonecrosis: natural course and conservative therapy].

[Article in German]
Hofmann S1, Mazières B.
  • 1Orthopädische Abteilung, LKH Stolzalpe, Osterreich. hofmann@murau.at

Abstract

The natural course of Osteonecrosis (ON) of the femoral head has yet not been evaluated sufficiently. Especially in the early forms of the disease (ARCO 0 to II) without collapse of the femoral head, useful information on the natural course could only be collected since the routine use of MR-imaging. The unspecific findings in ARCO stage I with negative radiographs are potential reversible. The “point of no return” already lies in the irreversible ARCO stage II in almost all cases. Prognosis for further progression for both early stages depends primarily on the extension and location of the lesion. Only the rare, small to medium sized lesions in the medial or central location may have a good prognostic course over a period of more than five years. The much more common large sized and lateral located lesions will have a probability of about 80% to progress to femoral head collapse within two years. Conservative therapy with single protected weight bearing has shown bad results not significantly different from the natural course of the disease. Pulsed electromagnetic fields are still discussed controversially. Until now there is no MRI controlled study available in early ON, showing superior results compared to the easy and cost-effective core decompression therapy. The extra corporal shock wave therapy has shown spontaneous pain relief in early ON. Midterm results of this new therapeutical concept are not available yet. Hyperbaric oxygen therapy has shown to stimulate the repair process in an animal experiment. The preliminary clinical results of this time and cost consuming therapy are not convincing. Vasoactive drugs in combination with limited weight bearing may play a role in the conservative management of early ON (ARCO I and part of ARCO II) in the future. For the conservative therapy in ON several other substance are currently in clinical testing. The benefit of conservative therapeutical concepts in ON in the future can only be evaluated with prospective MRI controlled clinical studies. The use of cytokines in combination with surgical debridement and bone grafting of the necrotic area may be a possible therapeutical concept for the future.

Food Sensitivity

Electromagn Biol Med 2014 Apr 8. [Epub ahead of print]

The effect of pulsed electromagnetic field therapy on food sensitivity.

Monro JA1, Puri BK.
  • 1Breakspear Medical Group , Hertfordshire , UK and.

Abstract

Abstract Owing to the involvement of the immune system in the etiology of food sensitivity, and because pulsed electromagnetic field therapy is associated with beneficial immunologic changes, it was hypothesized that pulsed electromagnetic fields may have a beneficial effect on food sensitivity. A small pilot study was carried out in patients suffering from food sensitivity, with the antigen leukocyte antibody test being employed to index the degree of food sensitivity in terms of the number of foods to which each patient reacted. It was found that a 1-week course of pulsed electromagnetic field therapy, consisting of one hour’s treatment per day, resulted in a reduction in the mean number of reactive foods of 10.75 (p?<?0.05). On the basis of these results, a larger study is warranted.

Ligament Repair

Lasers Med Sci.  2014 Apr 11. [Epub ahead of print]

Low-level laser therapy prevents degenerative morphological changes in an experimental model of anterior cruciate ligament transection in rats.

Bublitz C1, Medalha C, Oliveira P, Assis L, Milares LP, Fernandes KR, Tim CR, Vasilceac FA, Mattiello SM, Renno AC.
  • 1Department of Bioscience, Federal University of São Paulo, Av. Ana Costa, 95, Vila Mathias, Santos, SP, 11050-240, Brazil, carolinebublitz@yahoo.com.br.

Abstract

The aim of this study was to analyze the effects of low-level laser therapy (LLLT) on the prevention of cartilage damage after the anterior cruciate ligament transection (ACLT) in knees of rats. Thirty male rats (Wistar) were distributed into three groups (n=10 each): injured control group (CG); injured laser-treated group at 10 J/cm2 (L10), and injured laser-treated group at 50 J/cm2 (L50). Laser treatment started immediately after the surgery and it was performed for 15 sessions. An 808 nm laser, at 10 and 50 J/cm2, was used. To evaluate the effects of LLLT, the qualitative and semi-quantitative histological, morphometric, and immunohistochemistry analysis were performed. Initial signs of tissue degradation were observed in CG. Interestingly, laser-treated animals presented a better tissue organization, especially at the fluence of 10 J/cm2. Furthermore, laser phototherapy was able of modulating some of the aspects related to the degenerative process, such as the prevention of proteoglycans loss and the increase in cartilage area. However, LLLT was not able of modulating chondrocytes proliferation and the immunoexpression of markers related to inflammatory process (IL-1 and MMP-13). This study showed that 808 nm laser, at both fluences, prevented features related to the articular degenerative process in the knees of rats after ACLT.

Photomed Laser Surg. 2007 Jun;25(3):191-6

Effect of low-level laser therapy on healing of medial collateral ligament injuries in rats: an ultrastructural study.

Delbari A, Bayat M, Bayat M.

Avicenna Hospital, Tehran, Iran.

OBJECTIVE: This study sought to investigate whether low-level laser therapy (LLLT) with a helium-neon (He-Ne) laser would increase fibril diameter of transected medial collateral ligament (MCL) in rats.

BACKGROUND DATA: It has been shown that LLLT can increase ultimate tensile strength MCL healing.

METHODS: Thirty rats received surgical transect to their right MCL, and five were assigned as the control group. After surgery, the rats were divided into three groups: group 1 (n = 10) received LLLT with He-Ne laser and 0.01 J/cm(2) energy fluency per day, group 2 (n = 10) received LLLT with 1.2 J/cm(2) energy fluency (density) per day and group 3 (sham-exposed group; n = 10) received daily placebo laser with shut-down laser equipment, while control group received neither surgery nor LLLT. Transmission electron microscope (TEM) examination was performed on days 12 and 21 after surgery and dimension and density of ligament fibrils were measured. The data were analyzed by Student t-test and Mann-Whitney tests, respectively.

RESULTS: On day 12, the fibril dimension of group 2 and their density were higher than of groups 1 and 3.

CONCLUSION: LLLT with He-Ne laser on incised MCL in rats could not significantly increase fibril diameter and their density in comparison with sham-exposed group.

Photomed Laser Surg. 2005 Dec;23(6):556-60

Low-level laser therapy improves early healing of medial collateral ligament injuries in rats.

Bayat M, Delbari A, Almaseyeh MA, Sadeghi Y, Bayat M, Reziae F.

Cell and Molecular Biology Research Center, Medical School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. bayat_m@cyahoo.com

OBJECTIVE: This study sought to investigate whether or not low-level laser therapy (LLLT) with a helium-neon laser increased biomechanical parameters of transected medial collateral ligament (MCL) in rats.

BACKGROUND DATA: It has been reported that LLLT can enhance tendon healing.

METHODS: Thirty rats received surgical transection to their right MCL, and five were assigned as the control group. After surgery, the rats were divided into three groups: group 1 (n = 10) received LLLT with 0.01 J/cm(2) energy density per day, group 2 (n = 10) received LLLT with 1.2 J/cm(2) energy density per day, and group 3 (sham = exposed group; n = 10) received daily placebo laser with shut-down laser equipment, while the control group received neither surgery nor LLLT. Biomechanical tests were performed at 12 and 21 days after surgery. The data were analyzed by one-way analysis of variance.

RESULTS: The ultimate tensile strength (UTS) of group 2 on day 12 was significantly higher than that of groups 1 and 3. Furthermore, the UTS and energy absorption of the control (uninjured) group were significantly higher than those of the other groups.

CONCLUSIONS: LLLT with a helium-neon laser is effective for the early improvement of the ultimate tensile strength of medial collateral ligament injuries.

Connect Tissue Res. 2005;46(3):125-30

Combined treatment of therapeutic laser and herbal application improves the strength of repairing ligament.

Fung DT, Ng GY, Leung MC.

Orthopaedic Rehabilitation Research and Microscopy Laboratory, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China.

The present study investigated the effects of combined therapeutic laser and herbal medication protocols on injured medial collateral ligaments (MCLs) of rat knees. Fully 36 rats were evenly divided into 9 groups. Right MCLs of groups 1 to 6 and 8 were transected, while that of groups 7 and 9 remained intact. After surgery, group 1 was treated with 1 session of high-dosed laser; group 2 with 9 sessions of low-dosed laser; group 3 with an herbal plaster; groups 4 and 5 received combined treatments of groups 1 and ss and 2, and 3 respectively; groups 6 and 7 received only bandaging; groups 8 and 9 received placebo laser and no treatment, respectively. All MCLs were subjected to biomechanical testing at 3 weeks postsurgery. Results revealed significant differences among groups in ultimate tensile strength (UTS) and stiffness (p < 0.01). Combination of multiple low-dosed laser treatment with herbal treatment (group 5) resulted in higher UTS than either no treatment (groups 6 and 8), single high-dosed laser treatment (group 1), multiple low-dosed laser treatment (group 2), or herbal treatment (group 2) alone. We concluded that combined applications of laser and herb can enhance further biomechanical properties of repairing rat MCLs than separate applications at 3 weeks postinjury.

Photochem Photobiol. 2005 Feb 1; [Epub ahead of print]

In vivo Study of the Inflammatory Modulating Effects of Low Level Laser Therapy on in iNOS Expression Using Bioluminescence Imaging.

Moriyama Y, Moriyama EH, Blackmore K, Akens MK, Lilge L.

Ontario Cancer Institute Princess Margaret Hospital.

This study was designed to demonstrate that bioluminescence imaging (BLI) can be used as a new tool to evaluate the effects of low level laser therapy (LLLT) during in vivo inflammatory process. Here, the efficacy of LLLT in modulating inducible nitric oxide synthase (iNOS) expression using different therapeutic wavelengths was determined using transgenic animals with the luciferase gene under control of the iNOS gene expression. Thirty transgenic mice (FVB/N-Tg(iNOS-luc)Xen) were allocated randomly to one of four experimental groups treated with different wavelengths (lambda=635, 785, 808 and 905nm) or a control group (non-treated). Inflammation was induced by intra-articular injection of Zymosan A in both knee joints. Laser treatment (25mW.cm(-2), 200 s, 5 J.cm(-2)) was applied to the knees 15 minutes (or min) after inflammation induction. Measurements of iNOS expression were performed at various times (0, 3, 5, 7, 9 and 24h) by measuring the bioluminescence signal using a highly sensitive charge-coupled device (CCD) camera. The results showed a significant increase in BLI signals after irradiation with 635nm laser when compared to both the non-irradiated animals and the other LLLT treated groups indicating wavelength-dependence of LLLT effects on iNOS expression during the inflammatory process. Histological analysis was also performed and demonstrated the presence of fewer inflammatory cells in the synovial joints of mice irradiated with 635nm compared to non-irradiated knee joints. BLI demonstrated an action spectrum of iNOS gene expression following LLLT in vivo.

Lasers Surg Med. 2004;34(3):285-9.

Comparison of single and multiple applications of GaAlAs laser on rat medial collateral ligament repair.

Ng GY, Fung DT, Leung MC, Guo X.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. rsgng@polyu.edu.hk

Abstract

BACKGROUND AND OBJECTIVES: To examine single versus multiple applications of the gallium aluminum arsenide (GaAlAs) laser on the healing of surgically injured medial collateral ligaments (MCLs) in rats.

STUDY DESIGN/MATERIALS AND METHODS: Sixteen rats were studied, with 12 receiving surgical transection to their right MCL and 4 receiving a sham injury. Group 1 (n = 4) received a single dose of GaAlAs laser therapy (wavelength 660 nm, average power 8.8 mW, pulse 10 kHz, dosage 31.6 J/cm(2)) directly to their MCL during surgery. Group 2 (n = 4) received 9 doses of GaAlAs laser therapy applied transcutaneously on alternate days (wavelength 660 nm, average power 8.8 mW, pulse 10 kHz, dosage 3.5 J/cm(2)). The controls (Group 3, n = 4) received one session of placebo laser at the time of surgery, with the laser equipment shut down, while the sham injured Group 4 (n = 4) received no treatment. Biomechanical tests for structural stiffness, ultimate tensile strength (UTS), and load-relaxation were done at 3 weeks after injury. The stiffness and UTS data were normalized by expressing as a percentage of the left side of each animal before statistical analysis.

RESULTS: The load-relaxation data did not show any differences between the groups (P = 0.18). The normalized stiffness levels of Groups 2 (81.08+/-11.28%) and 4 (92.66+/-13.19%) were significantly higher (P = 0.025) than that of the control Group 3 (58.99+/-15.91%). The normalized UTS of Groups 2 (81.38+/-5.68%) and 4 (90.18+/-8.82%) were also significantly higher (P = 0.012) than that of the control (64.49+/-9.26%). Although, Group 1 had higher mean stiffness and UTS values than the control, no statistically significant difference was found between these two groups.

CONCLUSIONS: Multiple laser therapy improves the normalized strength and stiffness of repairing rat MCLs at 3 weeks after injury. The multiple treatments seem to be superior to a single treatment when the cumulative dosages are comparable between the two modes of application.

Lasers Surg Med. 2003;32(4):286-93.

Effects of a therapeutic laser on the ultrastructural morphology of repairing medial collateral ligament in a rat model.

Fung DT, Ng GY, Leung MC, Tay DK.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

Abstract

BACKGROUND AND OBJECTIVES: Low energy laser therapy has been shown to enhance mechanical strength of healing medial collateral ligament (MCL) in rats. The present study investigated its effects on the ultrastructural morphology and collagen fibril profile of healing MCL in rats.

STUDY DESIGN/MATERIALS AND METHODS: Thirty-two mature male Sprague-Dawley (SD) rats were used. Twenty-four underwent surgical transection to their right MCLs and eight received only skin wound. Immediately after surgery, eight of the MCL transected rats were treated with a single dose of laser therapy at 63.2 J cm(-2), eight were treated with a single dose of laser therapy at 31.6 J cm(-2), the rest had no treatment and served as control. At 3 and 6 weeks after surgery, the MCLs were harvested and examined with electron microscopy for collagen fibril size, distribution, and alignment.

RESULTS: Significant differences (P < 0.001) were found in fibril diameters from the same anatomical site and time period among different groups. The mass-averaged diameters of the laser-treated (64.99-186.29 nm) and sham (64.74-204.34 nm) groups were larger than the control group (58.66-85.89 nm). The collagen fibrils occupied 42.55-59.78, 42.63-53.94, and 36.92-71.64% of the total cross-sectional areas in the laser-treated, control and sham groups, respectively. Mode obliquity was 0.53-0.84 among the three groups.

CONCLUSIONS: Single application of low energy laser therapy increases the collagen fibril size of healing MCLs in rats.

Anterior Cruciate Ligament

Lasers Med Sci.  2014 Apr 11. [Epub ahead of print]

Low-level laser therapy prevents degenerative morphological changes in an experimental model of anterior cruciate ligament transection in rats.

Bublitz C1, Medalha C, Oliveira P, Assis L, Milares LP, Fernandes KR, Tim CR, Vasilceac FA, Mattiello SM, Renno AC.
  • 1Department of Bioscience, Federal University of São Paulo, Av. Ana Costa, 95, Vila Mathias, Santos, SP, 11050-240, Brazil, carolinebublitz@yahoo.com.br.

Abstract

The aim of this study was to analyze the effects of low-level laser therapy (LLLT) on the prevention of cartilage damage after the anterior cruciate ligament transection (ACLT) in knees of rats. Thirty male rats (Wistar) were distributed into three groups (n?=?10 each): injured control group (CG); injured laser-treated group at 10 J/cm2 (L10), and injured laser-treated group at 50 J/cm2 (L50). Laser treatment started immediately after the surgery and it was performed for 15 sessions. An 808 nm laser, at 10 and 50 J/cm2, was used. To evaluate the effects of LLLT, the qualitative and semi-quantitative histological, morphometric, and immunohistochemistry analysis were performed. Initial signs of tissue degradation were observed in CG. Interestingly, laser-treated animals presented a better tissue organization, especially at the fluence of 10 J/cm2. Furthermore, laser phototherapy was able of modulating some of the aspects related to the degenerative process, such as the prevention of proteoglycans loss and the increase in cartilage area. However, LLLT was not able of modulating chondrocytes proliferation and the immunoexpression of markers related to inflammatory process (IL-1 and MMP-13). This study showed that 808 nm laser, at both fluences, prevented features related to the articular degenerative process in the knees of rats after ACLT.