Orthopedics

Original Research 

EVALUATION OF THE DEGREE OF EFFECTIVENESS OF BIOBEAM LOW LEVEL NARROW BAND LIGHT ON THE TREATMENT OF SKIN ULCERS AND DELAYED POSTOPERATIVE WOUND HEALING

M Iusim, MD; J Kimchy, RPT; T Pillar, MD; D G Mendes, MD, FACS

Abstract

ABSTRACT

Twenty-one patients with 31 postoperative delayed open wounds resistant to conventional therapy were randomly allocated to three groups. Group 1 was treated with red low level narrow band (LLNB) light (660 nm); group 2 was treated with infrared LLNB light (940 nm); and group 3 was treated with a placebo such as the Biobeam machine (no light irradiation). Group 1 showed a significant improvement compared to groups 2 and 3 (t-test).

Abstract

ABSTRACT

Twenty-one patients with 31 postoperative delayed open wounds resistant to conventional therapy were randomly allocated to three groups. Group 1 was treated with red low level narrow band (LLNB) light (660 nm); group 2 was treated with infrared LLNB light (940 nm); and group 3 was treated with a placebo such as the Biobeam machine (no light irradiation). Group 1 showed a significant improvement compared to groups 2 and 3 (t-test).

The purpose of this prospective study was to evaluate the effect of the low level narrow band (LLNB) light treatment (Biobeam, Amcor Ltd, Israel) on skin ulcers and delayed postoperative wound healing. Few scientific studies have been reported on this subject in the literature.'·4 No protocol for phototherapy treatment is currently available to the medical community.

The possible socioeconomic impact of such a study becomes obvious when one considers the average cost for patients suffering from ulcers due to diabetes or peripheral vascular disease, healing complications of an operative wound following amputation, or buttocks or heel pressure sores in the postoperative course of nailing a hip fracture.

MATERIALS AND METHODS

Study Design. Forty-three patients (Table 1) were included in this study, which was carried out in two stages.

First stage: All patients were treated by red light. The purpose of this stage was to develop a general understanding of the effectiveness, complications, and side effects of the treatment (Table 2).

Second stage: Twenty-one patients with 31 wounds and a variety of diseases were treated with a randomly selected treatment mode. In this stage, conducted as double blind clinical trial, 33% of die patients were treated with active red mode, 33% with active infrared, and 33% with placebo (Table 2).

Each patient received 7 minutes of treatment of continuous wave, followed by 7 minutes of pulse wave, daily. All applications were focused on the same fixed point. The patients continued to receive their regular local and general treatment during the period of study (Table 3).

Table

Table 1POPULATION OF PATIENTS

Table 1

POPULATION OF PATIENTS

Table

Table 2PATIENTS STUDIED

Table 2

PATIENTS STUDIED

Table

Table 3TECHNICAL SPECIFICATIONS

Table 3

TECHNICAL SPECIFICATIONS

Table

Table 4Group 1 - Red

Table 4

Group 1 - Red

All variables that could influence the healing rate were identified and contro] led during this experimeni. All patients received a well balanced diet, including zinc, protein, and vitamin C. Blood tests for glucose, albumin, urea, and electrolytes were performed regularly.

Risk Analysis. Although found to damage the eyes at higher doses, infrared radiation does not cause damage to the eyes at the dosage used in this study.

Follow-up Regime. Clinical examination: Accurate measurements of the wounds were performed every 1 0 days.

Photographic assessment: Photos were taken al the start of treatment, every 15 days during the treatment, and at the termination of treatment. A ruler was used to indicate the measurements and to maintain the same photographic angle in every case.

RESULTS

In Group 1 (red LLNB) (Table 4), all patients showed improvement, two healed completely, and the total area of all wounds was reduced by 89% after an average of 20 days of treatment.

In Group 2 (infrared LLNB) (Table 5), all patients except for one showed improvement. In the one exception, one of the patient's three treated wounds worsened, but there was no change in the others. The total area of all the wounds in this group was reduced by 58%.

In Group 3 (placebo) (Table 6), two patients became worse and two showed no change. The total area of all the wounds was reduced by 41%.

DISCUSSION

Light biostimulation is often referred to as ultraviolet therapy or soft laser therapy. Low energy laser radiation was used under experimental and clinical conditions to stimulate wound healing and to treat inflammatory conditions. It proved to be more effective in stimulating wound healing than in treating inflammatory conditions.

Monochromaticity and coherency are the main properties of laser radiation. There is no commonly accepted theory explaining the mechanism of its influence, although several theories were developed in an attempt to clarify it.1,5,6

The biostimulation effect of various bands of light at the level of the cell or the organism was known long before the use of laser. Different wavelengths trigger certain biological functions such as photorepair,7 phototaxis,8 photoperiodic clocks,9 and cell division.5

The coherency of the laser disappears after penetration of the first layers of tissue. Sasonov et al10 established that coherent and noncoherent red light were equally effective in treating peptic ulcers clinically.

Karu6 established that biostimulation takes place only in a controlled range of light doses (wave and intensity). If the light dose is increased, it can destroy or block the photoacceptors (compounds absorbing light at wavelengths). If the energy is low, it cannot trigger the photoacceptors. Illumination of cells with wide band light causes almost no stimulative effect. Different cells have different photoacceptors and respond to different wavelengths. This could explain the differences between the response of the skin disorders to the red or infrared light. In our study the efficiency of LLNB on granulation and healing of wounds was proven statistically.

CONCLUSION

Published reports by various researchers indicate that phototherapy conducted under experimental and clinical conditions has a positive effect on wound healing. This study, conducted under regular hospital conditions, shows that the P value between the results of group 1 (red) and group 3 (placebo) was significant when computed by r-test (Table 7). This proves that low light narrow band treatment has a significant role in the treatment of skin ulcers and delayed postoperative wounds.

Table

Table 5Group 2 - Infrared

Table 5

Group 2 - Infrared

Table

Table 6Group 3 - Placebo

Table 6

Group 3 - Placebo

Table

Table 7RESULTS OF DOUBLE BLEVD STUDY

Table 7

RESULTS OF DOUBLE BLEVD STUDY

REFERENCES

1. Abergel RP. Biostimulation of wound healing by lasers: experimental approaches in animal models and fibroblast cultures. J Dermatol Surg Oncol 1987; 13:127.

2. Longo L. Effect of GaAIAs diode laser 904 nm on healing of experimental wounds. Lasers in Surgery and Medicine. 1987; 7:444.

3. Mester E, Kam TI, Kalendo GS, Letokhov VS, Lobko VV. Lasers in clinical practice. Acta Chirurgica Hungarica (Budapest). 1986; 9:335.

4. Mester AF, Mester AR. Scientific background of laser biostimulation. Laser. 1988; 1:23.

5. Kacu TL MioiYJ Cimento. 1982; 6:828.

6. Kam TI. Pholobiological fundamentals of low power laser therapy. Journal of Quantum Electronics. 1987; 10:23.

7. Seltow J. The molecular basis of ultraviolet radiation and photoreactivation. In: Ebert M, Howard A, eds, Current Topics in Radiation Research. Amsterdam: North-Holland Publishing Co; 1986.

8. Hadar DP. Photomovement. In: Haupt W, Fainleib ME, eds. Encyclopedia of Plani Physiolngy. New Series, vol 7. Berlin: Springer; 1979:268-309.

9. Bunning E. The Physiological. Clock, 3rd ed. Berlin: Springer; 1973.

10. Sasonov AM, Romanov GA, Portnoy M, et al. Low-intensity non-coherent red light in the comprehensive treatment of gastroduodenal ulcers. Sov Med. 12:42.

Table 1

POPULATION OF PATIENTS

Table 2

PATIENTS STUDIED

Table 3

TECHNICAL SPECIFICATIONS

Table 4

Group 1 - Red

Table 5

Group 2 - Infrared

Table 6

Group 3 - Placebo

Table 7

RESULTS OF DOUBLE BLEVD STUDY

10.3928/0147-7447-19920901-05

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