Page 74 - Veterinary Laser Therapy in Small Animal Practice

60 Veterinary Laser Therapy in Small Animal Practice

Table 7.1 Recommended parameters for management of mucocutaneous conditions.
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Example Dose (J/cm ) Power (W) Power density (W/cm )
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Acute superficial Skin incision, hot spot 2–5 1–3 0.1–0.5
Acute sacculitis, penetrating
Acute deep 4–6 3–6 0.3–1
wound
Chronic superficial Non-healing ulcer 4–25 2–4 0.3–0.6
Chronic deep Deep fistula 5–20 3–6 0.5–1.2

the wound bed, this would mean a total treatment area inflammation. But the effects on the tensile strength
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of 500 cm . So if you really want to apply those 4 J/ of the wound require more time to allow collagen and
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cm , you would need between 1000 and 2000 J, roughly fibroblasts to be produced, so resist the impulse to
2–3 times the original value! I am not saying treating a remove sutures at day 5, even if the wound looks really
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chronic wound with 2 J/cm will have no effect; but you pretty.
need to be aware of the applied J/cm , so if the wound In chronic wounds, treatment is usually performed
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does not progress the way you expected, you know initially every 48–72 h and can be even less frequent
what parameters you started with. later, but if possible, recheck no longer than 48 h after
Together with the wound margin, another strategy the first treatment and decide whether you want to
you can consider is to first treat the proximal blood continue with the same parameters or change them. I
supply area, and then the wound. This is often done in prefer not to spread treatments further apart until I see
human medicine when treating distal diabetic ulcers. a change in the wound.
Frequency of visits should be considered together
NOTE: Include at least the metacarpal/metatarsal with the type and amount of discharge, since this will
area when treating wound in the foot pads also determine the type and frequency of wound care. If
the wound requires daily bandage changes in the clinic,
Regarding frequency of treatment, these are the then perform LT at that time. If it’s every 2–4 days,
guidelines for an uncomplicated surgical/acute wound. adapt to that once the wound has started progressing;
it is not difficult to schedule both events together. This
• You may do the first treatment on the operat- way, we will avoid unnecessary bandage changes that
ing room table or in the immediate postoperative would increase the risk of wound infection and affect
period (unless there is active bleeding or onco- tissue regeneration, patient comfort, and cost of care.
logical concern), or at the time of initial wound
management. 7.2.1 Acute wounds
• If the patient is hospitalized, you may treat twice a
day for the first 24–48 h, or daily until it can leave Acute wounds (both traumatic and surgical) can be
the hospital and then at the rechecks: since most treated initially with 1–4 J/cm . What’s more, we can
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surgical and uncomplicated wounds are expected take advantage of LT before the procedure starts, as in
to heal uneventfully, you may treat during the first the example shown in Figure 7.2.
recheck at 24–48 h and the second recheck at 5–7 The first treatment of a surgical wound can be on
days. Some of these wounds will need no further the surgery table (Fig. 7.3), unless it is an oncological
treatment, but you may add a last treatment at the surgery and we want to wait for the pathology report to
time of suture removal. confirm surgical margins are clean enough.
• If you feel the wound deserves closer follow-up, If there is active bleeding, we do not want to laser
treat on 2–3 consecutive days and then treat the area of course, since the increased blood flow would
every 48 h until suture removal. worsen the hemorrhage. Just wait a bit and start the
treatment a few hours later. If cryotherapy is going to
Note that in acute surgical wounds, the first effect be used over the wound area after the surgical proce-
you will notice is a decrease in the expected degree of dure is completed, which can be very useful to decrease

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