Therapy of long-term non-healing wounds with laser radiation

Recently, a scientific-practical conference "CLINICAL AND TECHNOLOGICAL CHALLENGES IN STAGE AND RECONSTRUCTIVE SURGERY" was held in Kyiv, where leading surgeons from Ukraine, Belarus, Lithuania, and the Czech Republic took part. The report was of particular interest to the audience  specialists from Minsk  - professor,  head of the course of transplantology of the Department of Cardiac Surgery of BelMAPO on the basis of the 9th City Clinical Hospital.

Ivan Pikireni and Vladimir Khomchenko,  physicist, developer of Multiline ™,  on the topic "Rehabilitation and stimulation of the regeneration of long-term non-healing wounds and trophic ulcers with YAG:Er laser radiation". The speakers described the physical basis of the laser effect on tissues and presented numerous clinical cases of successful application of the method in surgical practice.

How laser radiation affects cells of various tissues

The first part of the report was devoted to the physical foundations. Thus, when laser radiation is absorbed with a pulse duration comparable with the thermal relaxation time of the cells of the irradiated tissues, their explosive evaporation occurs. In this case, the tissues evaporate at such a rate that the energy of the laser pulses does not penetrate into the surrounding tissues, but is converted into the energy of explosive acoustic waves. If there are several such areas, then, propagating into the tissues, acoustic waves begin to interfere. And at the same time, their total power in the places of interference may be sufficient for mechanical destruction. With such an impact, individual cells surrounded by intact functional tissues will be injured.

Erbium laser radiation based on the Multiline ® laser system, which is maximally absorbed by water, was used to implement this concept. The radiation was specially spatially transformed using the SMA module. As a result, radiation hits the surface of biological tissue not in the form of a continuous wide spot, but in the form of structured microspots with a diameter of 50 microns and located at a distance of 50 microns from each other.

The power of acoustic waves is calculated in such a way that it is not enough for the independent destruction of cell structures, and the destruction occurs only in the places of interference.

By changing the energy or duration of laser pulses, it is possible to change both the depth of damage and the degree of microtrauma.

An essential nuance that allows the desired result to be achieved is that the laser radiation is completely absorbed in the very surface layer. In this case, no wound surface is formed, only a cellular structure of slight microablation is observed, and the effect on the deep layers of tissues is non-thermal. Thus, an ordered structure of micro-destructions surrounded by functioning cells is created. Since the destroyed cells do not pose a threat to organs and tissues, the recovery mechanism is launched, and not the growth of fibrous tissue. 

In response to such mechanical destruction, all reparative processes are activated, cytolytic enzymes, necrophils, macrophages, fibroblasts, and mast cells are activated, which is confirmed by skin electron microscopy data immediately after SMA treatment. There is a noticeable increase in vascularization, fibroblasts appear, which carry out the synthesis of the matrix of the intercellular substance, and the skin structure is restored. Thus, as a result of exposure, we see the growth of young functional tissues without the formation of fibrosis.

The developed method of exposure was called the SMA method, and the method of laser stimulation of repair in aesthetic medicine was called RecoSMA, which has been used for many years for skin rejuvenation in laser medicine clinics in Ukraine, Russia, Belarus, Kuwait, Spain, etc. & nbsp; In this case, we get the effect of true, and not pseudo-rejuvenation, in which the lifting effect is carried out by creating a fibrous framework.

In the period from 2011 to 2015, only in the network of LINLINE clinics more than 100 thousand laser procedures RecoSma ™ were performed in almost 50 thousand patients, both for the purpose of rejuvenation and treatment cicatricial tissue changes.

The impact was carried out on almost all areas of the human body. Considering the brilliant results of using the SMA method for skin rejuvenation and the treatment of cicatricial changes, an assumption arose about the effectiveness of the method in the treatment of trophic ulcers and long-term non-healing wounds.

Clinical studies on the effects of laser radiation on tissues

A clinical study of the SMA method of repair stimulation was carried out in the City Clinical Hospital No. 9, Minsk. The method was used to treat trophic ulcers of various origins in 23 patients and long-term non-healing wounds in 14 patients. The SMA method was used in combination with surface treatment with an erbium laser (wavelength 2936 nm) before exposure to SMA. This mode allows for painless ablation of wounds with visual control of the depth of exposure.  After cleansing the wound, the wound surface and surrounding tissues are treated with the SMA module, followed by the application of a dry dressing.  Microbiological examination of the surface of wounds after treatment with an erbium laser did not inoculate microorganisms.

Independent testing of the method was carried out in the hospital of Terragona (Spain) in the treatment of trophic ulcers in 17 patients, showing good treatment results.

Another study investigated the use of the SMA method in patients with long-term non-healing wounds of the anterior abdominal wall after multiple relaparotomies in patients with concomitant diabetes mellitus, immunosuppression after liver and kidney transplantation. So in one of the patients after appendectomy, it took two treatments with the SMA method to apply secondary sutures and induce healing, in another patient with pancreatic necrosis, after 16 relaparotomies, it took a week to prepare the wound for the application of secondary sutures.

In another presented clinical case in a patient after kidney and pancreas transplantation, with subsequent development of pancreatic necrosis and removal of the pancreas, Pseudomonas aeruginosa was sown from a long-term non-healing postoperative wound against the background of immunosuppression. This patient also had good results with SMA wound debridement.

As a rule, the time for preparing wounds for secondary sutures when treating with the SMA method (monotherapy, without treatment by any means) was 7-9 days.

Thus, scientists have provided convincing evidence that the unique patented method of treating the skin with the SMA module based on the Multiline ™ system is a safe and effective method of stimulating repair both in rejuvenation and in long-term non-healing wounds.