Laser Debridement: Can It Have An Impact For Chronic Wounds?
Offering pertinent insights on key principles and the biological effects of laser technology, these authors examine the possibilities of this modality for the debridement of lower extremity ulcerations.
Ever since its emergence in early 1960s, laser technology has occupied an important niche in medicine and surgery. Today, a great number of specialties utilize lasers. These specialties include dentistry, dermatology, ophthalmology, otolaryngology and vascular surgery. Laser applications include the treatment of hypertrophic scars, removal of skin lesions, laparoscopic surgery, vein ablation and many others.1 Unfortunately, to date, the use of lasers in the field of podiatry has mostly been limited to the treatment of onychomycosis.2 Meanwhile, a deeper integration of the laser technology into the podiatric practice may offer the means of improving therapeutic outcomes of many difficult to treat conditions.
Chronic lower extremity ulcers affect a significant portion of the adult population worldwide and represent one of the most common problems podiatrists see.3 Debridement is the cornerstone of wound management. Studies suggest that wounds treated with serial debridements demonstrate lower infection rates and heal faster in comparison to wounds that receive less frequent debridement or no debridement at all.4,5 Researchers have commonly attributed these effects to the role of debridement in reducing bacterial bioburden, eliminating excessive pressure, the stimulation of cytokine and growth factor release, and the facilitation of drainage.6
While many types of debridement are currently available, sharp debridement is the method of choice for the majority of physicians due to its efficiency and convenience.7 The major drawbacks of surgical debridement are the lack of uniform technique and procedural pain. In a retrospective study of 143 patients with diabetic foot ulcers treated by different providers in wound care centers across the country, Saap and Falanga noted significant inconsistency in the quality of surgical debridement, which strongly correlated with the variability in the wound closure rates.8 Procedural pain is another limiting factor commonly associated with sharp debridement. While neuropathic patients generally tolerate sharp debridement well, individuals with venous and arterial ulcers may experience significant debridement-associated discomfort, which could limit the extent of the procedure and deem the treatment less effective.9
Laser debridement is one of the lesser known wound debridement techniques and it has mostly been limited to burn treatment so far.10-13 Its advantages include precision and uniformity of tissue ablation, which reduces trauma to the wound bed, improved patient comfort, and potentially the promotion of wound healing. Accordingly, let us take a closer look at the rationale for using lasers in the management of chronic lower extremity wounds and present the preliminary data that suggest the efficacy of such treatment.
A Primer On The Principles Of Laser Technology
Lasers are electro-optical devices that emit a focused beam of intense monochromatic light in visible and infrared radiation spectrums. Laser technology is based on the principle of stimulated emission of radiation postulated by Einstein in 1917. The first laser was built by Maiman in the early 1960s. Since then, people have utilized lasers successfully in many fields, including medicine and surgery.14
The human body absorbs laser energy to a different extent depending on the wavelength of laser radiation and specific properties of light-absorbing molecules or chromophores within the target tissues. Chromophores are a diverse group that include melanin, hemoglobin and most importantly, water.14