In the following case study, a non-invasive low level laser therapy (LLLT) approach to wound repair proved efficacious in accelerating healing. A 29-year-old Caucasian female with second degree scalding water burns to right, left thighs, abdomen, and flank responded to LLLT as the principal treatment for wound case management.
History
The patient was injured as a result of accidental leakage of boiled water from a rubberized hot water bottle placed on the pelvic/abdominal region for menstrual cramp reduction. The patient, non-ambulatory and non-verbal with cerebral palsy, was unable to alert caregiver of scalding water penetration in sufficient time. The patient was evaluated at a local emergency hospital and the burn wounds were cleaned, dressed with bacitracin ointment 60g, adaptic dressings, and gauze dressings. Patient’s vital signs were stabilized and discharged for continued home therapy for wound management. Drug therapy consisted of 8cc Tylenol with codeine #3 every 4 hours and Augmentum antibiotic for 10 days. Wound dressings with 1% silver sulfadiazine for the morning dressing and bacitracin for evening dressing were utilized. The patient continued under medical supervision by her personal physician.
Concurrent Condition
At birth, the patient had developed cerebral palsy from fetal viral infection (cytomegalovirus) and cyanosis. She was diagnosed with failure to thrive syndrome as an infant. The patient is now non-ambulatory and non-verbal except for primitive vocal sounds and gestures with head and arms. This patient’s past medical conditions include bronchitis, sleep apnea, and anemia. The patient previously underwent surgery for ocular corrections. This patient is presently on no medications. She is presently taking liquid iron, elemental molybdenum, and eating a mediterranean diet for nutritional support.
Objective Information
Patient height is 42 inches and weight is 39 lbs. Her BP was 107/57. Physical examination revealed rapid, shallow breathing, and mild clammy skin of face, arms, and spine. Patient is awake and shows signs of mild apparent distress.
Findings
A second degree burn on the right thigh measuring 11cm x 7cm with large waxy, white centering and a burn on the left thigh, second degree, measuring 12cm x 7cm is noted. A second degree burn on the left abdominal flank and back measuring 31cm x 12cm with waxy, white centering surrounded by erythemia is also noted (see Figure 1).
Assessment. Second degree burns to right and left thighs, abdominal flank and back.
Plan
Application of LLLT at lesion sites to facilitate the cellular responses to inflammation, pain, circulation, and lymph drainage. Accelerate wound healing by affecting fibroblasts for cellular ATP production, collagen synthesis, and scar tissue remodeling.¹
The low level laser to be used is the TerraQuant MQ 2000 which combines:
1. IR laser radiation 0.4-1.6mW 900+/-50nm
2. IR LED radiation 30-90mW 860-960nm
3. Red LED radiation 2-10mW 600-740nm
4. Static Magnetic Field 25-45mt
Total radiation is 60-90mW, with pulsed laser power at 8-24W.²
Implementation
The LLLT treatment protocols³ call for two-day intervals for the first week using programmed frequencies for wounds, burns and inflammation care by focusing on the cells well below skin surface and treating cells in the different layers of skin on three treatment dates. The emitter was held at 90 degrees to the tissues and scanned over the surface margins of the burns and scanned 1cm above the waxy, white centralized lesions. Dosimetry: a total of two applications of 1000Hz frequency at 4 min. intervals (skin layers) and with two applications of 50Hz frequency at five minute intervals (for the below skin layer) was delivered to the total area of the injured sites. Due to the size of the wounds, quantity of injured tissues, their neurological integrity, and the total body size of the patient, scanning techniques using both contact and non-contact methods were utilized.⁴
Second and Third Week Protocols
Dosimetry. Programmed frequencies 2x of 1000-3000Hz for edema reduction, lymphatic drainage, cellular turnover, and proliferation and scanned from the wound centers outward to the margins. Programmed frequencies 2x of 1000Hz for skin cell regeneration, increase of microcirculation, reduction of scar tissue formation.
Status. Hypertrophic scarring and raised margins around each wound, reddened centers of increased circulation, and decreasing waxy, white plaques (see Figure 2).
Assessment. Patient comfort level considerably improved. Discontinued usage of Tylenol with Codeine. No evidence of bacterial invasion of the wounds. Change in wound dressing to replace bacitracin and silver sulfadiazine with Silver Shield Cosmetic Gel with Aqua Sol Technology. Course of Augmentum oral antibiotic was run to completion. Liquid Silver Shield with AquaSol Technology 18ppm pure silver colloidal and ionic used daily, 5ml.
Fourth to Eighth Week Protocol
Dosimetry. Program frequencies of 1x 1000-3000Hz, 1x 1000Hz, 1x 50 Hz , at 90 degree scanning from central to peripheral margins with non-contact. Treatment intervals varied between five to seven days and up to 14 days.
Status. Wounds exhibit less suppuration, lessening areas of hypertrophic scarring, wound closure narrowing, absent signs of bacterial activity.
Assessment. Patient comfort levels continue to improve, no signs of distress exhibited. Discontinued use of Silver Shield Cosmetic Gel with Aqua Sol Technology. Began usage of Vitamin E ointment (AtriDerm) over wounds and scars and wrap with gauze dressings.
Assessment. Continuation of Liquid Silver Shield daily dosing of 5ml.
Ninth to Fourteenth Week Protocol
Dosimetry. Program frequencies of 1x 1000-3000Hz or 1x 1000Hz, with 1x 50Hz per treatment. Scanning method utilized from center to periphery of each wound with non-contact at centers and contact at outer margins. Treatment schedule varied from seven to fourteen day intervals.
Status. Wounds exhibit diminished total length and width of necrotic and damaged tissues (see Figure 3). New epidermal layers flattened without hypertrophic scarring. Outer perpipheral margins with melanin layering.⁵
Assessment. Continuation of LLLT at 7 -10 day intervals until all burn lesions have healed thoroughly and until all scar margins are cosmetically acceptable.
Case Study Summary
A 29-year-old Caucasian female, non ambulatory with cerebral palsy suffered second degree scalding water burns to right, left thighs, abdomen and flank that responded to LLLT as the principle treatment for wound case management. Over 14 weeks, the sizing of each lesion diminished as healed tissues replaced the necrotic tissues. There was no visible evidence of opportunistic bacterial infection or invasion. The newly replaced skin has shown evidence of increased tensile elasticity. Scar formation changed from raised margins to flattened, smooth blending patterns. Inflammatory markers (edema, redness, heat and pain) were in concert with the levels of tissue healing per treatment with the laser. Waxy, white burned centers were replaced with healthier pink cutaneous tissues as granulation ensued. Increased lymphatic drainage allowed for cellular waste removal and reduction of inflammatory mitigators. Overall comfort level of the patient was improved each week as determined by demeanor and sleeping patterns.
Clinical Outcomes
The clinical outcomes in this case represent the speed, efficiency, and efficacy of the use of LLLT in cases of skin conditions. Wound care management is well cited in the literature of LLLT as well as in the protocols from various manufacturers since the inception of phototherapy in the 1960s.⁶⁻⁸
Because of the direct skin contact in this case, the visible outcomes of the effects of quantum medicine with second degree burns was seen rapidly at the cellular level—particularly due to the turnover rate at the epidermis.⁹Most notable was increased vascularity using the 1000-3000Hz program.¹⁰
The rate of decreasing edema, increased lymphatic drainage, and increased phagocyte activity brought the reduction of central wound margins as the tissues were healing from the centers to the periphery. Increased fibroblastic activity was seen in the cellular proliferation rates between treatments. Increased collagen and epithelial production emerged new skin margins without overproduction of scarred inelastic tissues in the outer margins of the lesions.
Photonic emissions of laser diodes target injured cellular tissue components, primarily the chromophores, flavoproteins, and porphrins.¹¹Light energy transforms into biochemical energy which begins a sequence of events to activate ATP production and synthesis, transportation of nutrients and oxygen to damaged cells, removal of cellular debris via lymphatic drainage, and increased synthesis of signaling proteins—all of which result in accelerated healing.¹²
Summary
The mechanics of low power lasers to influence cellular ATP production is the key to increasing the rate of DNA synthesis. The wavelengths to stimulate this production are the 635nm and 820 nm ranges.¹³ The use of LLLT sources with these two wavelengths will induce more protein synthesis and result in increased cell proliferation benefiting, as in this case, burn wound repair. Low level laser does not raise the temperature of the tissue being irradiated by more than one degree, thus thermal damage is not possible and change comes via biochemical, bioelectrical, and biomagnetic effects.¹⁴˒¹⁵ Repeated doses of pulsed laser light amplify cellular and systemic effects. Proper technique when scanning the injured tissues, frequency of treatments, as well as repair time intervals, and burn wound dressings consistent with medical protocols, all contributed to the efficient healing of the burn wounds and limitation of keloid and hypertrophic scarring.¹⁶⁻¹⁸
In this study, a non-invasive approach to wound repair was efficacious and should encourage clinicians to utilize this modality of LLLT to accelerate healing, and improve symptoms and outcomes for patients with potential burn scarring.
References
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