Effects of Photobiomodulation and Split-Thickness Skin Grafting in the Prognosis of Wound Healing in Children with Deep Burn Ulcers

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Abstract

Background: Split-thickness skin grafting (STSG) is a standard therapeutic technique in patients with extensive and deep ulcers. Hospitalization and surgery can result in complications, especially in children. Photobiomodulation (PBM) has been applied in a variety of conditions such as healing of surgical, venous, pressure, and diabetic wounds, but no clinical trial using this method for healing of burn ulcers in children was found on searching the literature. The aim of the study was to evaluate the effect of PBM on the outcome of burn ulcers in children.

Materials and methods: Informed consent and protocols were reviewed according to Shahid Beheshti University of Medical Sciences’ Medical Ethics Board (IR.SBMU.REC.1394.363) and the Iranian Registry of Clinical Trials (IRCT2016011726069N1). Forty children with deep burn ulcers, who were candidates for STSG, were divided into PBM and STSG groups. A 650-nm laser (power 150 mW, spot size 0.6 cm2, time 10 sec, and energy point 1.5 J) was used for irradiation over the burn area every other day until complete healing in the PBM group. STSG was performed in the STSG group. All other therapeutic care protocols were identical.

Results: Thirty-nine children completed the study. The mean ulcer size in the two groups was similar before treatment (PBM = 60.72 cm2 ± 13.8 and STSG = 63.74 ± 7.6). In the PBM group, all wounds healed within 10–12 sessions. Analysis of the burn area was performed 1, 3, and 6 months after injury. There was a significant difference (t test) in the burn area after 6 months in the PBM group compared with the STSG group (t test; p > 0.001).

Conclusions: This is the first study to compare PBM and STSG in burn ulcers in children. Results indicated that PBM was an effective alternative to STSG, significantly decreasing the rate of scar and hypertrophic scar formation. Potential mechanisms of PBM that may be involved in burn tissue repair are discussed.

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Clinical and radiological assessment of the effect of low level laser therapy on delayed bone fractures healing

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Low level laser has been conducted for treatment of bone fracture on animal and had shown positive results. If laser energy is delivered at optimal dose with appropriate parameters ,it might get best results however a little research in the literature has conducted on the effect of low level laser on human bone fracture. The aim of the study was to assess the radiological and clinical difference of the effect of low level laser therapy on the delayed bone healing of patients with different bone fractures.

 

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New insight into how light therapy can speed up burn wound healing

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A compelling new study is offering an insight into the mechanism by which a novel form of light therapy can speed the healing of burn injuries. The research indicates the experimental therapy can activate a key protein that stimulates cell growth.

 

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Photobiomodulation therapy assists rapid recovery from burns

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University at Buffalo project identifies mechanisms behind light-enhanced healing.

The therapeutic effects of incident light on wounds or sites of injury are known to be potentially beneficial in treatment regimes, and the mechanisms behind the effect are becoming increasingly understood.

A project at the University at Buffalo (UB) has now examined the effects of photobiomodulation (PBM) therapy specifically on burn wounds.

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Accelerated burn wound healing with photobiomodulation therapy involves activation of endogenous latent TGF-β1

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Abstract

The severity of tissue injury in burn wounds from associated inflammatory and immune sequelae presents a significant clinical management challenge. Among various biophysical wound management approaches, low dose biophotonics treatments, termed Photobiomodulation (PBM) therapy, has gained recent attention. One of the PBM molecular mechanisms of PBM treatments involves photoactivation of latent TGF-β1 that is capable of promoting tissue healing and regeneration. This work examined the efficacy of PBM treatments in a full-thickness burn wound healing in C57BL/6 mice. We first optimized the PBM protocol by monitoring tissue surface temperature and histology. We noted this dynamic irradiance surface temperature-monitored PBM protocol improved burn wound healing in mice with elevated TGF-β signaling (phospho-Smad2) and reduced inflammation-associated gene expression. Next, we investigated the roles of individual cell types involved in burn wound healing following PBM treatments and noted discrete effects on epithelieum, fibroblasts, and macrophage functions. These responses appear to be mediated via both TGF-β dependent and independent signaling pathways. Finally, to investigate specific contributions of TGF-β1 signaling in these PBM-burn wound healing, we utilized a chimeric TGF-β1/β3 knock-in (TGF-β1Lβ3/Lβ3) mice. PBM treatments failed to activate the chimeric TGF-β1Lβ3/Lβ3 complex and failed to improve burn wound healing in these mice. These results suggest activation of endogenous latent TGF-β1 following PBM treatments plays a key role in burn wound healing. These mechanistic insights can improve the safety and efficacy of clinical translation of PBM treatments for tissue healing and regeneration.

Scientific Reports | June 28, 2021

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Accelerated burn wound healing with photobiomodulation therapy involves activation of endogenous latent TGF-β1

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Abstract

The severity of tissue injury in burn wounds from associated inflammatory and immune sequelae presents a significant clinical management challenge. Among various biophysical wound management approaches, low dose biophotonics treatments, termed Photobiomodulation (PBM) therapy, has gained recent attention.

—Scientific Reports

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Treatment of diabetic foot ulcers in a frail population with severe co-morbidities using at-home photobiomodulation laser therapy: a double-blind, randomized, sham-controlled pilot clinical study

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Photobiomodulation at home, in addition to standard care, may be effective for the treatment of severe DFUs in frail patients with co-morbidities and is particularly relevant at these times of social distancing. Our preliminary results justify the conduction of a larger clinical trial. ClinicalTrials.gov: NCT01493895.

—Springer Link

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Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach

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Abstract

GENERAL PURPOSE:

To provide background and examine evidence for the therapeutic application of light energy treatments for wound healing.

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be better able to:

1. Explain the basics of lasers, light-emitting diodes, and light-tissue interactions as they apply to photobiomodulation therapy.

2. Summarize the results of the authors’ literature review of the evidence regarding the therapeutic applications of photobiomodulation treatments for wound healing.

OBJECTIVE:

To provide background and examine evidence for the therapeutic applications of light energy treatments for wound healing.

METHODS:

A search was performed in PubMed for peer-reviewed scientific articles published in the last 5 years using the search terms “photobiomodulation therapy” and “low-level laser therapy,” and these terms combined with “wound,” using a “human species” filter. This search yielded 218 articles on photobiomodulation therapy or low-level laser therapy and wounds. Of these, only articles on in vivo wound care using light treatments were specifically included in this review (n = 11).

RESULTS:

The wound healing effects of low-dose laser treatments were first described over 50 years ago. Various doses ranging from 0.1 to 10 J/cm2 and wavelengths ranging from 405 to 1,000 nm appear to provide therapeutic benefits for a broad range of chronic wounds. A range of light energy sources from LEDs to lasers have been used and have specific advantages and limitations. There is a lack of consensus on standardized treatment parameters such as wavelengths, dose, and therapeutic outcomes in the reviewed studies, preventing direct comparison and clinical protocol recommendation. An expert opinion based on ongoing research studies and reported literature is offered.

CONCLUSIONS:

Noninvasive, economical, and multipurpose light devices are an attractive tool for wound management. However, there is an urgent need in the wound care community to develop optimal clinical protocols for use based on well-designed, rigorous clinical research studies.

—Advances in Skin and Wound Care

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The Skinny on Fats in Wound Healing

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The sequential wound healing cascade promotes optimal repair. However, prolonged or overly vigorous individual phases impede healing. Although most wound therapies focus on initiating the healing process by supplementing growth factors or matrices, the study by Hellmann et al. highlights the role of lipid molecules termed resolvins, specifically RvD1 and RvD2, as promoters of epithelial wound closure.

—Journal of Investigative Dermatology

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Noninvasive red and near-infrared wavelength-induced photobiomodulation: promoting impaired cutaneous wound healing

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The innumerable intricacies associated with chronic wounds have made the development of new painless, noninvasive, biophysical therapeutic interventions as the focus of current biomedical research. Red and near-infrared light-induced photobiomodulation therapy appears to emerge as a promising drug-free approach for promoting wound healing, reduction in inflammation, pain and restoration of function owing to penetration power in conjunction with their ability to positively modulate the biochemical and molecular responses. This review will describe the physical properties of red and near-infrared light and their interaction with skin and highlight their efficacy of wound repair and regeneration. Near-infrared (800–830 nm) was found to be the most effective and widely studied wavelength range followed by red (630–680 nm) and 904 nm superpulsed light exhibiting beneficial photobiomodulatory effects on impaired dermal wound healing.

—Wiley Online Library

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