Introduction
The skin grafts are the common surgical treatment for wound cover in Plastic surgery. The donor site of the skin grafting site expected to be healed without any complication or abnormal scarring. Low-level laser therapy (LLLT) or Photo biomodulation (PBM) is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body.1 The data suggests that LLLT facilitates collagen synthesis,2 keratinocyte cell motility,3 growth factor release3 and transforms fibroblasts to myofibroblasts.4 In this article we report the use of Low-Level Laser therapy in augmenting the wound healing of the skin graft donor site.
Materials and Methods
This study was conducted in the Department of Plastic Surgery in a tertiary care institute. Informed consent was obtained from the patient under study. Department scientific committee approval was obtained. It is a single center, non-randomized, non-controlled study. LLLT was applied to the skin graft donor site in two patients.
The patient 1 under study was a 63-year-old female, with no other known co morbidities presented with a non-healing venous ulcer on the right leg. Her wound was managed according to international standard guidelines. A split thickness skin graft was harvested on her right upper thigh for closure of the wound. Low level laser therapy was applied to the skin graft donor site to facilitate wound healing (Figure 1).
The patient 2 under study was a 45-year-old male, with no known comorbidities had electrical burns over chest, abdomen, right thigh. His wound was managed according to guidelines. A split thickness skin graft was taken from his left thigh for wound cover. Low level laser therapy was applied to the skin graft donor site to facilitate wound healing (Figure 2).
LLLT was given to the wound bed in four sessions once in 5 days for a total of four session, after each session of wound inspection and dressing. Gallium Arsenide (GaAs) diode red laser (wavelength 650 nm, frequency 10 kHz and output power 100 mW) was used as a source of LLLT. It is a continuous beam laser with an energy density of 4 J/cm2. Machine delivers laser in scanning mode (non-contact delivery) with 60 cm distance between laser source and wound. In each session, the wound was given laser therapy for duration of 125 second followed by non-adherent absorbent dressing.
Results
Donor site healed well after low level laser therapy session (Figure 1, Figure 2). Post therapy period was uneventful.
Discussion
Low level Laser uses energy much less than that is used for cutting, ablation therapy.4 By definition Low-level lasers are one with power density less than 500 mW/cm.2 LLLT is used as an adjuvant to conventional therapy with promising results, in patients with ulcers.5 LLLT is a form of phototherapy that use electromagnetic radiation. LLLT does not generate heat but produces photochemical and photophysical effects, with the intention of re-establishing cell homeostasis. Essentially, light energy is delivered topically in a controlled, safe manner and it is absorbed by photo-absorbers (chromophores) that transform it into chemical energy.6 Positive effects of LLLT are: It accelerates tissue repair, increases the formation of granulation tissue, helps in wound contraction, decreases inflammation, modulation, and it also helps in pain reduction.7, 8, 6, 9 According to the literature, low-energy photoemissions given at a wavelength range of 600nm to 900nm accelerates cell proliferation and wound healing processes.9 Its action is thought to: Stimulate respiratory chain components such as flavin and cytochromes which increase adenosine triphosphate (ATP) synthesis, thus enhancing the rate of mitoses and increasing fibroblast numbers, stimulate collagen and elastin production, leading to better reepithelialisation, stimulate microcirculation and dilatation of the capillaries and neovascularisation to increase tissue oxygenation, liberate mediator substances such as histamine, serotonin and bradykinin to influence macrophages, regenerate lymphatic vessels.
Numerous case reports and clinical trials with humans have shown impressive wound healing outcomes using LLLT. Further work with animals has also supported the use of LLLT to facilitate wound healing.10, 11 The exact mechanism by which LLLT facilitates wound healing is largely unknown. However, several theories may help explain the enhanced wound contraction observed here. In vitro studies have shown an increase in fibroblast proliferation after therapy.11, 12 suggesting that LLLT therapy may facilitate fibroplasia during the repair phase of tissue healing. Pourreau-Schneider et al,4 who reported that laser irradiation transforms fibroblasts into myofibroblasts. Myofibroblasts are directly involved in granulation tissue contraction, and increased numbers could lead to facilitated wound contraction. A myofibroblast is a modified fibroblast with ultrastructural and functional properties of fibroblasts and muscle cells. Cytoplasmic fibrils of actomyosin allow for contraction of myofibroblasts, pulling on the borders of the wound and reducing the size during the repair phase of soft tissue healing.13 LLLT may have caused release of tissue growth factors into circulation, which may have affected surrounding tissues or entire systems. Indirect healing could be a very beneficial effect of this modality in treating tissue damage of large size or at multiple locations. It might also suggest that deeper tissues could be affected by light therapy.
