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Pointing light at soft tissue: clinical applications 75

Once the patient improves, decrease the frequency of
treatment. For chronic cases, once apparently healed, it
is recommended to recheck and treat every 2–4 weeks,
depending on the case. Use these visits to palpate and
empty the anal sacs if necessary.

7.7 Hygroma (false bursitis)

This is a false bursa that can develop over bony promi-
nences and pressure points. If a lot of fluid is present,
drainage may be necessary, and of course bandaging
and proper padding of surfaces. It is not uncommon to
need 6–15 treatments. The most common location is
the elbow, where it can be mistaken for true bursitis,
since there is a true bursa situated under the tendon of
the triceps brachii, where it crosses the proximal part
of the olecranon (bursa subtendinea olecrani). Be aware
that these are different clinical entities; a true bursa is
an anatomical structure that cushions moving parts,
such as tendons, ligaments, and muscles. True bursitis
is associated with pathological changes in the associ-
ated structures (tendon straining, fracture, etc.), for
example in shoulder bursitis/tenosynovitis, and treat-
ment has to consider this.
Surgery is usually the last option for elbow hygro-
mas, due to the risk of wound breakdown and chronic
ulceration, and damage to the triceps tendon and true
Figure 7.15 This type of cap allows comfortable treatment of bursa. Chronic ulcers of the elbow can heal with LT
the perineal area and it is easy to disinfect. and proper wound care; or you can choose to improve
tissues locally, get a partial closure, and then perform
LT has also been investigated in humans for the surgery over healthy tissue – but as previously men-
treatment of anal fissure with some clinical results. [226] tioned, LT can avoid many flaps.
Patients in the laser group significantly improved after A callus usually develops over the false bursitis, but a
5–10 sessions: pain, spasm, bleeding, and constipation chronic cavity may persist below the surface, with alter-
decreased, by as much as in the group that received nating chronic fistulae – again, LT would be your best
botulinum toxin injections for chemical sphincterot- option here. Treat hygromas and callus (Fig. 7.16) as
omy, with no side effects. chronic wounds in terms of parameters, although very
Treat fistulae like deep chronic wounds, in non- often you will be able to treat in contact and improve
2
contact mode, with 2–4 W and 4–20 J/cm (Table penetration.
7.6). Include all the perineal area (tuber ischiadicum to
base of tail). The patient may be reluctant to have its 7.8 Gingivitis and stomatitis
tail raised initially, but this will soon improve. In severe
cases, start treating on 2–3 consecutive days; milder The main benefits of LT (tissue healing, decreased
cases can be treated every other day for 2–3 weeks. pain and inflammation) can also be applied to the oral

Table 7.6 Recommended parameters for perineal treatments.
Dose (J/cm ) Power (W) Power density (W/cm )
2
2
4–20 2–4 0.5–1

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