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88 Veterinary Laser Therapy in Small Animal Practice

Case no. 4

D.J., canine, 1 year old, Briard, MNC, 23 kg
• Complaint: wound.
• History: he underwent surgery for elbow pseudo bursitis and had dehiscence at surgical incision. After
two more attempts to close the wound with tension-relieving suture patterns, it was left to heal by second
intention, but was not progressing. Also, D.J. kept licking the elbow area and owner refused to use E-collar.
He was referred for LT.
• Physical examination: open chronic wound over caudal surface of the right elbow. The skin defect was 20
cm (Fig. C4.1a), and showed immature granulation, but for at least 2 cm around it the skin was detached
2
from the underlying tissue (Fig. C4.1b). The holes left by the previous sutures were inflamed and had not
healed. Small amounts of exudate were present.
• Diagnosis: chronic wound.
• Treatment:
• Wound management:
• The day of the first treatment, approximating skin sutures were placed in an attempt to improve the
adherence of the skin.
• Lavage and covering with polyurethane foam as a primary layer.
• Laser therapy:
• The initial treatment area becomes 150 cm if we want to include the unhealthy margin plus 2–3 cm of
2
2
apparently healthy tissue. With an initial dose of 5 J/cm , that becomes 750 J per session. As the skin
2
around the wound healed, the treatment area was decreased but never below 50 cm .
• Dose was increased to 10 J/cm in the final stages, so the total amount of energy per session
2
oscillated between 500 and 750 J.
• Outcome: wound closure after 18 sessions. A shorter resolution time would probably be expected without the
self-trauma component.

Figure C4.1 Before treatment. (a) Caudal and (b) lateral views. Figure C4.2 Five days and two Figure C4.3 Day 12.
treatments later.

Figure C4.4 Day 25. (a)
Caudal and (b) lateral
views. Figure C4.5 Day 40.

2
P (W) Tx time J/cm 2 Total J/Tx Spot (cm ) W/cm 2 Tx/week No. Tx
a
166 s (2.7 min)–
3 5–10 500–750 8 0.4 2-3 18
250 s (4.2 min)

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