Lasers moving slowly into treatment of wounds
January 1, 1998 3 minutes read
Lasers moving slowly into treatment of wounds
More research trials are coming
Lasers have secured a solid position in several areas of medicine. For instance, dermatologists routinely rely on the devices to remove vascular and pigmented lesions, such as port-wine stains, lentigines, and tattoos, and to excise hemangiomas. Gynecologists use lasers to perform endometrial ablations and a number of other procedures. In fact, just about every surgical specialty has at least flirted with lasers at one time or another, with varying degrees of success.
The same may occur in wound care, but so far the use of lasers has been limited to the preclinical realm or to theoretical constructs.
Low-energy lasers (whose impact on tissue occurs outside of the visual realm) have been tested for their wound-healing capabilities for nearly two decades, says Janet H. Prystowsky, MD, PhD, a dermatologist and assistant professor of clinical dermatology at Columbia-Presbyterian Medical Center in New York City. The idea of using the device, she explains, is to stimulate fibroblasts to promote collagen growth and therefore accelerate wound healing. Unfortunately, results from the few studies that have been conducted are conflicting, and no practical clinical applications have resulted.
The story may advance differently for widely used surgical lasers, which either cut, coagulate, or vaporize tissue. "Now that we’re doing carbon dioxide laser resurfacing of skin, it seems like a good time to take a look at lasers in wound healing," says Prystowsky. "If we use the CO2 laser on skin, for example, we can demonstrate increased deposition of collagen as the skin heals over the laser-treated tissue. I’d like to use the laser to debride wounds, such as chronic leg ulcers, with the hope that by vaporizing the necrotic tissue over ulcers, we can remove tissue we think impeded healing. At the same time, through mechanisms that I don’t think anyone can explain at this point, we would hope that the actual thermal injury or thermal stimulation caused by the laser on the remaining tissue will result in enhanced collagen formation and healing."
Prystowsky has planned clinical studies involving CO2 laser treatment of patients with chronic wounds of the lower extremities, such as venous ulcers.
She adds that lasers are already used to "weld" tissue to repair some types of surgical wounds and to perform reverse vasectomies. In these applications, the laser is used to heat up protein in the tissue’s albumin, forming an organic "solder" that solidifies into a permanent tissue weld.
Newer models of high-powered CO2 lasers can also be used to vaporize precise amounts of tissue without damaging underlying structures, says James Spencer, MD, MS, director of Mohs surgery at the University of Miami (FL). This characteristic might prove to be helpful for wound debridement, because surgeons could conceivably use lasers to remove dead tissue while sparing underlying vital tissue, he explains.
Another type of laser, the pulsed-dye laser, has been shown to improve hypertrophic scarring and may find a role in wound healing. "These lasers have an effect on fibroblasts. Maybe that effect can be applied in wound healing. We don’t yet know," says Spencer, who plans to conduct wound-related studies using both the CO2 and pulsed-dye lasers at the University of Miami.
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