Page 80 - Veterinary Laser Therapy in Small Animal Practice

66 Veterinary Laser Therapy in Small Animal Practice

looks dry, you should either space changes further apart opaque dressings should be removed to perform LT
in time, or switch to a less absorbent type of dressing. over a wound. If you want to maintain that primary
layer intact, you could still remove the tertiary and sec-
A study of burn wounds showed LT was sufficient ondary bandage layers and laser the periphery of the
to stimulate myofibroblastic differentiation, wound.
but when it was combined with cellulose films Having the best materials available is ideal, to make
or sodium alginate/chitosan-based dressings it sure you need fewer bandage changes, improve patient
improved epithelialization, angiogenesis, and comfort, and promote healing. Nevertheless, if these
collagen synthesis with a higher proportion of types of dressings are not available or affordable, you
organized type I collagen. [212] can still do decent wound management with cotton-
based gauzes and paddings. Remember to avoid loose
Once granulation tissue starts to appear or the cotton that could leave some threads in the wound,
amount of exudate is moderate, polyurethane foams use a sterile contact layer (with some hydrocolloid
and hydrocolloids are a good choice. In this stage, ointment if possible), and if there is thick exudate, to
bandage changes usually take place every 2–4 days. remove it using a wet-to-dry technique.
Check the dressing to make sure it is not too saturated So when a bandaged wound comes in, the overall
and if so, consider more frequent changes or a more plan is as follows. First, remove bandages and cover-
absorbent material such as alginate. If there is little ings. If they are stuck to the wound surface, which is
exudate, bandage changes are often postponed to every avoided in moist wound care technique, moisten with
3–5 days; hydrocolloids will maintain optimal moisture, saline to facilitate separation. Inspect and smell these
and when there is extra desiccation risk, a hydrogel is materials. Lavage the wound with lactated Ringer solu-
added. Manuka honey is also useful and can be added in tion or, as a second option, with sterile saline, to remove
all phases – it sounds more sticky and messy than it is; debris and reduce biofilm and inflammatory mediators.
it is worth trying if you haven’t already done so. Much Perform the LT. If the wound has signs of infection, you
more novel than honey, a new type of dressing based may lavage with antiseptics after this, preferably with
on a galactomannan matrix made from locust bean chlorhexidine at 0.05% concentration: a higher con-
gum and an antioxidant hydration solution containing centration can inhibit healing, and a lower concentra-
curcumin and N-acetyl-L-cysteine (HR006) has been tion is not enough to be antiseptic. After a few minutes
marketed, which forms a hydrogel matrix that is able to of contact, wash the antiseptic off with more lactated
absorb exudates while promoting an optimal microen- Ringer solution and cover again with a new dressing
vironment that enhances healing. [213, 214] With this type and bandage. Consider sedation if necessary, depend-
of product, the primary dressings are usually changed ing on the amount of manipulation, discomfort, pain,
every 5–7 days, which can be a great advantage. or stress expected with the procedure and the patient’s
Some membrane-type wound dressings and gels clinical situation.
may transmit more than 50% of the laser light. [215]
Quite an extensive study was performed with differ- 7.2.5 How to improve results
ent kinds of occlusive wound dressings and wave-
lengths, [216] showing that, depending on the material of • A+ Wound care: LT helps create a better local
the dressing and the wavelength, the amount of power environment to promote wound healing, because
transmitted could range from 96% to 0% of the incident perfusion increases, oxygen delivery improves,
power. Hydrocolloids and thin, translucent dressings white blood cells work more efficiently, there is less
all allow transmission of more than 40%. Others, such necrosis and an overall better metabolism. But you
as opaque tape and bands, activated charcoal, and other still need to lavage, debride, cover, and manage the
absorbent dressings, allow very little to no power trans- wound properly. Good wound care acts synergisti-
mission. Opacity and thickness, rather than density or cally with your LT, but poor wound management
the presence of any adhesive, were the most relevant will decrease or eliminate the positive effects of LT.
factors. The 904 nm beam had the highest transmissiv- It is not a magic wand – you cannot do LT and
ity. So you may consider keeping the gel/translucent forget about the rest.
membrane dressing and increasing exposure time; but • Don’t be afraid to increase stimulation: as we

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