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Pointing light at soft tissue: clinical applications 63

(a) (b) (c)

Figure 7.4 (a) Hematoma and swelling 24 h after surgery for lipoma in the sternal area. Laser treatment was used with a low
2
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dose of 2 J/cm but over a 200 cm area. (b) 48 h later tumefaction and hematoma have improved and a second treatment is
performed. (c) The last picture was taken another 48 h later.
the “bad” news is that with laser therapy available, you bacterial infection and hypoxia are common problems
will need to perform less reconstructive surgical pro- in chronic wounds, and both can benefit from laser
cedures, since some cases will resolve with LT. But of therapy (see Chapter 2 and Chapter 5, section 5.6, for
course this is beneficial for the patient. more on LT and blood flow as well as treating infected
tissues). The conclusion is that although in vitro results
7.2.2 Chronic wounds are sometimes contradictory about the effect of LT on
bacteria, in vivo studies show bacterial counts decrease
First of all, what really is a chronic wound? The Wound with LT, whether this is the result of a direct antimi-
Healing Society defines a chronic wound as “one that crobial effect, a consequence of the immune mod-
has failed to proceed through an orderly and timely ulation, or a combination of both. This is interesting
reparative process to produce anatomic and functional in all infected tissues, but especially when there is a
integrity or has proceeded through the repair process multi-resistant infection or when antibiotics are not
without establishing a sustained anatomic and func- well tolerated.
tional result.” So it may be taking too long to close, not The usual starting dose for chronic wounds is 4–5
2
progressing at all, reopening after an initial closure, J/cm , but some chronic cases will require gradual
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etc., but LT can help in most cases. increases up to 20–30 J/cm . In a clinical case series,
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The reasons behind chronicity can be multiple, but doses ranging from 6 to 21 J/cm were used. [211]

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