Abstract
Background and objective: Low intensity laser irradiation remains a controversial treatment for non-healing wounds. This study examines the effect of low intensity light on healing of infected skin wounds in the rat.
Materials and methods: Wounds on the rat dorsum were inoculated with Pseudomonas aeruginosa. Wounds were irradiated or sham-irradiated three times weekly from day 1 to 19 using 635-nm or 808-nm diode lasers delivering continuous wave (CW) or intensity modulated (3800 Hz) laser radiation, all at radiant exposures of 1 and 20 J/cm2. Wound area and bacterial growth on the wound surface were evaluated three times a week. Histological and immunohistochemical analyses were performed at day 8 and 19.
Results: Wounds that were irradiated using a wavelength of 635 nm (1 and 20 J/cm2) or intensity modulated 808-nm laser light at 20 J/cm2 were smaller in area at day 19 than the sham-irradiated controls (achieved significance level=0.0105–0.0208) and were similar to controls in respect of bacterial growth. The remaining light protocols had no effect on wound area at day 19 although they increased Staphylococcus aureus growth across the time line compared with controls (p<0.0001 to p<0.004). CW 808-nm light at 20 J/cm2 significantly delayed half-heal time. Histological and immunohistochemical analyses supported wound closure findings: improved healing was associated with faster resolution of inflammation during the acute phase and increased signs of late repair at day 19. Significant inflammation was seen at day 19 in all irradiated groups regardless of radiant exposure, except when using 635 nm at 1 J/cm2.
Conclusions: Red light improved healing of wounds. Only one 808-nm light protocol enhanced healing; lack of benefit using the remaining 808-nm light protocols may have been due to stimulatory effects of the light on S. aureus growth.
Zusammenfassung
Hintergrund und Zielsetzung: Low-Intensity-Laserbestrahlung bleibt eine umstrittene Behandlung von nicht heilenden Wunden. Diese Studie untersucht die Wirkung von Laserlicht niedriger Intensität auf die Heilung von infizierten Wunden der Haut am Rattenmodell.
Materialien und Methoden: Wunden auf dem Rücken von Ratten wurden mit dem Pseudomonas aeruginosa geimpft und anschließend dreimal wöchentlich, beginnend am Tag 1 bis zum Tag 19, bestrahlt oder scheinbestrahlt. Für die Laserbestrahlung wurden ein kontinuierlich abstrahlender (continuous wave, cw) 635 nm-Diodenlaser oder ein 808 nm-Diodenlaser im cw- bzw. intensitätsmodulierten (3800 Hz) Modus verwendet, jeweils mit einer Energiedichte von 1 und 20 J/cm2. Die Wundbereiche und das Bakterienwachstum an der Wundoberfläche wurden dreimal wöchentlich ausgewertet. Histologische und immunhistochemische Analysen wurden am Tag 8 und 19 durchgeführt.
Ergebnisse: Wunden, die mit einer Wellenlänge von 635 nm (1 und 20 J/cm2) oder mit intensitätsmoduliertem 808 nm-Laserlicht bei 20 J/cm2 bestrahlt wurden, waren am Tag 19 in der Fläche kleiner als die scheinbestrahlten Proben (erreichtes Signifikanzniveau=0,0105 bis 0,0208) und in Bezug auf das Bakterienwachstum vergleichbar mit der Kontrollgruppe. Die anderen Bestrahlungsprotokolle hatten keinen Einfluss auf den Wundbereich am Tag 19, führten über die Zeit aber zu einem im Vergleich zur Kontrollgruppe erhöhten Staphylococcus aureus-Wachstum (p<0,0001 bis p<0,004). Hingegen hat die kontinuierliche 808 nm-Laserbestrahlung mit 20 J/cm2 die Heilung verzögert. Die histologischen und immunhistochemischen Analysen unterstützen die Wundverschlussbefunde: die verbesserte Heilung ging mit einem schnellen Rückgang der Entzündung während der akuten Phase einher und es gab erhöhte Anzeichen für eine späte Reparatur am Tag 19. In allen bestrahlten Gruppen und unabhängig von der verwendeten Energiedichte – außer bei der Verwendung von 635 nm bei 1 J/cm2 – wurde am Tag 19 eine deutliche Entzündung gesehen.
Schlussfolgerungen: Rotes Licht verbessert die Heilung von Wunden. Nur ein 808 nm-Bestrahlungsprotokoll verbesserte die Heilung; der fehlende Nutzen der restlichen 808 nm-Bestrahlungsprotokolle lässt sich möglicherweise auf die stimulierende Wirkung des Lichts auf das S. aureus-Wachstum zurückführen.
This work was made possible by a grant from the Canadian Institutes of Health Research IMH-67522.
References
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