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Skin Integrity and Pressure Injuries

Laser Treatment

Lasers have been used in the treatment of wounds since the 1970s because of the belief that fibroblast activity and tissue granulation in the proliferative phase of non-healing, chronic wounds are enhanced. Currently the use of laser to promote wound closure in chronic wounds is not supported by evidence (Houghton et al. 2013; Houghton & Campbell 2007; Consortium of Spinal Cord Medicine 2000) and the two relevant studies are presented and discussed below.

Author Year
Country
PEDro Score
Research Design
Sample Size

Methods

Outcome

Taly et al. 2004
India
RCT
PEDro=10
N=35
Population: Mean age=8-65 yr; Gender: males=27, females=8; Stage of ulcers: Stage 2=55, Stage 3=8, Stage 4=3.
Intervention: Treatment for the experimental group consisted of multiwavelength light therapy (galliumaluminum arsenide laser source) in addition to conventional treatment. For the control group, the light therapy source was held over the ulcer after switching off the beam. 14 treatments were given, 1 every other day, three times per wk. Treatments ended when the ulcer healed or after the 14 treatment exposures.
Outcome Measures: Number of ulcers that healed.
1. Overall no significant differences were found between the control and treatment groups. 14 ulcers healed completely in the control group compared to 18 in the treatment group (p<0.802).
2. The mean time taken to heal was 2.45 wk in the treatment group and 1.78 in the control group (p<0.330).
3. Multi-wavelength light therapy reduced the time taken by a small subgroup of stage three and four ulcers to reach stage two, treatment group (n=4) 2.25 wk; control group (n=5) 4.33 wk (p=0.047).
Nussbaum et al. 1994
Canada
RCT
PEDro=6
NInitial=20; NFinal=16
Population: Mean age=15-61 yr.
Intervention: Control group received “standard” wound care consisting of twice daily cleansing with Hygeol (1:20) and Jelonet dressing, and avoidance of pressure on existing ulcers; Laser group received standard wound care plus laser treatment 3x/wk; Ultrasound/Ultraviolet C (US/UVC) group received standard wound care with US and UVC treatments alternating over a 5 day period.
Outcome Measures: Healing rate, ulcer size.
1. US/UVC and laser treatment with US/UVC showing greater effect on wound healing than laser or control. Mean percentage of change per wk in ulcer size from day 0 to complete healing for control (32.4%), US/UVC (53.5%), and laser (23.7%).
2. Several subjects showed deterioration over the study. Ulcers increased in size; (laser=3, 62- 167% change; control=1, 58% change; US/UVC=1, 1% change). All ulcers healed by end of study with last ulcer healed in laser group by wk 20 as opposed to US/UVC group at wk 6.

Discussion

Taly et al. (2004) studied 35 subjects (64 ulcers) using multi-wavelength light therapy compared to “standard” wound care alone. Overall, no significant differences were found between the two groups with regard to the number of ulcers healed and time taken to heal. Nussbaum et al. (1994) studied 16 patients and compared standard wound care alone or combined with either laser or Ultrasound/Ultraviolet C (US/UVC). Results showed that laser treatment combined with standard wound care had the least effect on wound healing compared to the control group and US/UVC group. A significant difference was found between the groups with the US/UVC treatment demonstrating a greater effect on wound healing. Both of these studies demonstrated that laser treatment was no more effective in promoting wound healing than standard wound care alone, post SCI.

Conclusion

There is level 1 evidence (from two randomized controlled trials: Taly et al. 2004; Nussbaum et al. 1994) that laser treatment has no added benefit in pressure injury healing post-SCI than standard wound care alone.

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