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Pointing light at soft tissue: clinical applications 73

Table 7.5 Recommended parameters for otohematoma.
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Dose (J/cm ) Power (W) Power density (W/cm )
2
4–6 1–3 0.2–0.5

For acute otitis and severe flare-ups, consider treat- (Table 7.5). If you have placed an otohematoma pad,
ing daily for 2–3 days, then spread out treatments to you obviously have to treat from the external/convex
every 48 h, then 72 h, according to progression. For surface of the pinna, so you can use about double the
chronic cases you can start treating three times a week dose and power/power density. If you want to apply
and then decrease to twice a week once there is an cold packs, do it before you laser the area. If you have
improvement; do not decrease the frequency of treat- placed sutures, it is probably a good idea to leave them
ment until you notice a clinical response. You should for 14–21 days, even if the skin wound healing is accel-
notice an improvement in 1–2 weeks, otherwise recon- erated, since sutures here are holding the cartilage and
sider treatment and/or diagnosis. not just the skin.

7.5.2 Aural hematomas 7.6 Sacculitis and perianal fistulas

Most aural hematomas have a concurrent otitis that Most acute cases of anal sac impaction do not require
explains the ear shaking, scratching, and trauma that systemic therapy, although some patients will feel
break the blood vessels in the pinna’s cartilage. A few more comfortable with a short-term course of non-
cases will report trauma without otitis, and a few others steroidal anti-inflammatory drugs (NSAIDs). The very
will have an underlying condition that interferes with mild cases just require sac expression; moderate ones
blood coagulation (e.g. ehrlichiosis) – you may want to benefit from flushing (using a small gauge IV Teflon
check this if there is absolutely no otitis or history of catheter, for instance) and packing with antimicrobial
trauma. and anti-inflammatory topicals. In both cases, LT can
There are almost as many approaches for aural provide fast and side-effect-free relief of the local pain
hematomas as for cruciate ligaments. If drainage and and inflammation. In severe cases with fistulous tracts
bandaging is your preferred approach and works for and cellulitis, systemic medication should be added,
you, I will not try to convince you to change and do but LT will accelerate fistula healing (Figs 7.13 and
more surgeries. If the punch technique is your thing, 7.14).
keep doing it. My preferred treatment is surgery with If the patient tolerates it, and there is no open wound
transfixation mattress sutures (always monofilament), or fistula, treat in contact mode to improve penetration.
with or without an otohematoma pad – the pad helps If the hand-piece can’t be properly cleaned afterwards
to keep the ear straight but makes it more difficult to due to its design, cover it with a disposable or disinfect-
use the laser and clean the wound. Whatever you do, able cap (Fig. 7.15). Improving penetration can be more
LT will help to: important in German Shepherds than in other breeds,
since their sacs are located more deeply, lying against
• absorb the hematoma faster the rectal wall.
• produce less exuberant fibrosis, with a better cos-
metic result If you choose to use a disposable/disinfectable cap,
• decrease the inflammation associated with the otitis make sure it has been approved by the laser
and/or surgical procedure manufacturer. Some of these plastics can
• make the patient more comfortable, which will also absorb/attenuate the light. And virtually
decrease trauma to the ear. all of them will do so if there are any
scratches or debris in the light’s path, so
Use 4–6 J/cm , with 1–3 W and a power density be sure to keep these clean and dry when in use.
2
of 0.2–0.5 W/cm , very similar and with the same
2
frequency as you would do with a wound or otitis

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