An Open-Label Study of Low-Level Laser Therapy Followed by Autologous Fibroblast Transplantation for Healing Grade 3 Burn Wounds in Diabetic Patients
Journal of Lasers in Medical Sciences,
Vol. 10 No. Supplement (2019),
1 December 2019
,
Page S7-S12
Abstract
Objective: This case series describes successful management grade 3 burn ulcers in 10 diabetic patients using Autologous Fibroblast Transplantation along with Low-Level Laser Therapy.
Background: Low Level Laser Therapy (LLLT) has been used as an effective therapeutic modality since the mid sixties. Although there are several clinical studies using LLLT in wound healing especially diabetic, pressure and venous ulcers, but there are rare reports of using this technique in burn ulcers. In this study for the first time we used LLLT along with antilogous fibroblast skin transplantation to treat grade 3 burn ulcers in diabetic patients.
Materials and Methods: Ten diabetic patients with grade 3 burn ulcer, candidate for skin graft surgery entered the study. 1 Cm2 was biopsied using punch. Fibroblasts were extracted and cultured in-vitro. Patients were treated using LLLT in 3-4 weeks that took time that fibroblast cultures become ready to use. Laser irradiation was done using red red light, 650 nm, 150 mW, 1 J/ cm2 for the bed of the ulcer and infra red light 808 nm, 200 mW, 6 J/ cm2 for the margins every other day for 10 sessions. Then a thin layer of fibroblast suspension was applied to the base of ulcer using sterile sampler and its surface was covered by Vaseline gauze.
Result: All patients healed completely in 10-12 weeks. No adverse effects were reported.
Conclusion: We conclude that this method can be used as an effective method for treating large wounds especially in complicated patients including diabetics.
- Low level laser Therapy
- Autologous Fibroblast Transplantation
- Regenerative Medicine
How to Cite
References
Ghanassia E, Villon L, dit Dieudonné J-FT, Boegner C, Avignon A, Sultan A. Long-term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers a 6.5-year follow-up study. Diabetes Care. 2008;31(7):1288- 92. doi: 10.2337/dc07-2145
Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in
individuals with diabetes. Diabetes Care. 2006;29(6):1288-93. doi: 10.2337/dc05-2425
Shakespeare P. Burn wound healing and skin substitutes. Burns. 2001;27(5):517-22. doi: 10.1016/S0305- 4179(01)00017-1
Taheri A, Mansoori P, Al-Dabagh A, Feldman SR. Are corticosteroids effective for the prevention of scar formation after second-degree skin burn? J Dermatol Treat. 2014;25(4):360-2. doi: 10.3109/09546634.2013.806768
Wong T, McGrath J, Navsaria H. The role of fibroblasts in tissue engineering and regeneration. Br J Dermatol. 2007;156(6):1149-55. doi: 10.1111/j.1365-2133.2007.07914.x
Wisser D, Steffes J. Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts
in burn trauma. Burns. 2003;29(4):375-80. doi: 10.1016/S0305-4179(03)00013-5
Fimiani M, Pianigiani E, Di Simplicio FC, Sbano P, Cuccia A, Pompella G, et al. Other uses of homologous skin grafts and skin bank bioproducts. Clinic Dermatol. 2005;23(4):396-402. doi: 10.1016/j.clindermatol.2004.07.025
Zare S, Anjomshoa M, Kurd S, Chai J-K, Dahmardei M, Nilforoushzadeh MA, et al. Regenerative medicine: novel approach in burn wound healing. J Skin Stem Cell. 2015;2(2):e30351. doi: 10.17795/jssc30351
Jaffary F, Changizi V, Mardani H, Kakanezhadian P, Javadi FM, Nilforoushzadeh MA, et al. Macroscopic effect of blue light cure on wound healing in NMRI mice NMRI. Adv Biomed Res. 2014;3(1):106. doi: 10.4103/2277-9175.129699
Llanos S, Danilla S, Barraza C, Armijo E, Piñeros JL, Quintas M, et al. Effectiveness of negative pressure closure in the integration of split thickness skin grafts: a randomized, double-masked, controlled trial. Ann Surg. 2006;244(5):700-5. doi: 10.1097/01. sla.0000217745.56657.e5
Bihari I, Mester AR. The biostimulative effect of lowlevel laser therapy of long-standing crural ulcers using helium-neon laser, helium-neon plus infrared lasers, and noncoherent light: preliminary report of a randomized double blind comparative study. Laser Ther. 1989;1(2):97-8.
Almeida‐Lopes L, Rigau J, Zângaro RA, Guidugli‐Neto J, Jaeger MM. Comparison of the low level laser therapy effects on cultured human gingival fibroblasts proliferation using different irradiance and same fluence. Lasers Surg Med. 2001;29(2):179-84. doi: 10.1002/lsm.1107
Moravvaej H, Daneshvar L, Saeedi M, Barzegar MR. Treatment of a pigmented hypertrophic scar by low-level laser therapy (LLLT): a case report. J Lasers Med Sci. 2010;1(1):35-8. doi: 10.22037/jlms.v1i1.2135
Dahmardehei M, Kazemikhoo N, Vaghardoost R, Mokmeli S, Momeni M, Nilforoushzadeh MA, et al. Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.
Lasers Med Sci. 2016;31(3):497-502. doi: 10.1007/s10103-016-1896-9
Kazemi-Khoo N. Successful treatment of diabetic foot ulcers with low-level laser therapy. Foot. 2006;16(4):184-7. doi: 10.1016/j.foot.2006.05.004
KazemiKhoo N, Ansari F. Blue or red: which intravascular laser light has more effects in diabetic patients? Lasers Med Sci. 2015;30(1):363-6. doi: 10.1007/s10103-014-1672-7
Khamseh ME, Kazemikho N, Aghili R, Forough B, Lajevardi M, Dabaghian FH, et al. Diabetic distal symmetric polyneuropathy: effect of low-intensity laser therapy. Lasers Med Sci. 2011;26(6):831-5. doi: 10.1007/ s10103-011-0977-z
Kazemi Khoo N, Iravani A, Arjmand M, Vahabi F, Lajevardi M, Akrami SM, et al. A metabolomic study on the effect of intravascular laser blood irradiation on type 2 diabetic patients. Lasers Medl Sci. 2013;28(6):1527-32. doi:10.1007/s10103-012-1247-4
Khoo NK, Shokrgozar MA, Kashani IR, Amanzadeh A, Mostafavi E, Sanati H, et al. In vitro therapeutic effects of a low-level laser at mRNA level on the release of skin growthfactors from fibroblasts in diabetic mice. Avicenna J Med Biotechnol. 2014;6(2):113-8.
Mokmeli S, Khazemikho N, Niromanesh S, Vatankhah Z. The application of low-level laser therapy after cesarean section does not compromise blood prolactin levels and lactation status. Photomed Laser Surg. 2009;27(3):509-12.doi: 10.1089/pho.2008.2314
Kazemi Khoo N, Babazadeh K, Lajevardi M, Dabaghian FH, Mostafavi E. Application of low-level laser therapy following coronary artery bypass grafting (CABG) surgery. J Lasers Med Sci. 2014;5(2):86-91. doi: 10.22037/jlms.
v5i2.4564
Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. Foot Ankle Surg. 1996;35(6):528-31.doi: 10.1016/S1067-2516(96)80125-6
Nilforoushzadeh MA, Jaffary F, Siavash M, Ansari N, Siadat AH, Heidari A. Autologous fibroblast suspension for the treatment of refractory diabetic foot ulcer. Indian J Dermatol Venereol Leprol. 2016;82(1):105-6. doi:10.4103/0378-6323.172905
Vaghardoost R, Momeni M, Kazemikhoo N, Mokmeli S, Dahmardehei M, Ansari F, et al. Effect of low-level laser therapy on the healing process of donor site in patients with grade 3 burn ulcer after skin graft surgery (a randomized clinical trial). Lasers Med Sci. 2018;33(3):603-7. doi: 10.1007/s10103-017-2430-4
Kazemikhoo N, Vaghardoost R, Dahmardehei M, Mokmeli S, Momeni M, Nilforoushzadeh MA, et al. Evaluation of the effects of low level laser therapy on the healing process after skin graft surgery in burned patients (a randomized clinical trial). J Lasers Med Sci. 2018;9(2):139-43. doi: 10.15171/jlms.2018.26
Isitt CE, McCloskey KA, Caballo A, Sharma P, Williams A, Leon-Villapalos J, et al. An analysis of surgical and anaesthetic factors affecting skin graft viability in patients admitted to a Burns Intensive Care Unit. Scars Burn Heal. 2016;2: 1-11. doi: 10.1177/2059513116642089
Leclerc T, Thepenier C, Jault P, Bey E, Peltzer J, Trouillas M, et al. Cell therapy of burns. Cell Prolif. 2011;44(1):48-54. doi: 10.1111/j.1365-2184.2010.00727.x
Burke JF, Yannas IV, Quinby WC Jr, Bondoc CC, Jung WK. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Ann Surg.1981;194(4):413-28. doi: 10.1097/00000658-198110000-00005
Braye F, Oddou L, Bertin-Maghit M, Belgacem S, Damour O, Spitalier P, et al. Widely meshed autograft associated with cultured autologous epithelium for the treatment of major burns in children: report of 12 cases. Eur J Pediatr Surg. 2000;10(1):35-40. doi: 10.1055/s-2008-1072320
Owen C, Murphy H, Yates VM. Tissue‐engineered dermal skin grafting in the treatment of ulcerated necrobiosis
lipoidica. Clin Exp Dermatol. 2001;26(2):176-8. doi: 10.1046/j.1365-2230.2001.00789.x
Nilforoushzadeh MA, Siadat AH, Arianrad M, Moulavi F, Baradaran EH, Esfahani MHN. Soft tissue augmentation by autologous cultured fibroblasts transplantation for treatment of wrinkles and scars: a case series of 20 patients. J Res Med Sci:2010;15(3):167-71.
Woodruff LD, Bounkeo JM, Brannon WM, Dawes KS, Barham CD, Waddell DL, et al. The efficacy of laser therapy in wound repair: a meta-analysis of the literature. Photomed Laser Surg. 2004;22(3):241-7. doi:10.1089/1549541041438623
Schindl A, Schindl M, Pernerstorfer-Schön H, Schindl L. Low-intensity laser therapy: a review. J Investig Med.2000;48(5):312-26.
Beckerman H, de Bie RA, Bouter LM, De Cuyper HJ, Oostendorp RA. The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther. 1992;72(7):483-91. doi: 10.1093/ptj/72.7.483
Lucas C, van Gemert MJ, de Haan R. Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomised clinical trial. Lasers Med Sci . 2003;18(2):72-7. doi: 10.1007/s10103-003-0259-5
Cambier DC, Vanderstraeten GG, Mussen MJ, van der Spank JT. Low-power laser and healing of burns: a preliminary assay. Plast Reconstr Surg. 1996;97(3):555-8. doi: 10.1097/00006534-199603000-00009
Mester E, Spiry T, Szende B, Tota JG. Effect of laser rays on wound healing. Am J Surg. 1971;122(4):532-5. doi:10.1016/0002-9610(71)90482-X
Dantas MD, Cavalcante DR, Araújo FE, Barretto SR, Aciole GT, Pinheiro AL, et al. Improvement of dermal burn healing by combining sodium alginate/chitosan-based films and low level laser therapy. J Photochem Photobiol B. 2011;105(1):51-9. doi: 10.1016/j.jphotobiol.2011.06.009
Bayat M, Vasheghani MM, Razavi N, Taheri S, Rakhshan M. Effect of low-level laser therapy on the healing of seconddegree
burns in rats: a histological and microbiological study. J Photochem Photobiol B. 2005;78(2):171-7. doi:
1016/j.jphotobiol.2004.08.012
Ezzati A, Bayat M, Taheri S, Mohsenifar Z. Low-level laser therapy with pulsed infrared laser accelerates thirddegree burn healing process in rats. J Rehabil Res Dev. 2009;46(4):543-54. doi: 10.1682/JRRD.2008.09.0121
Gaida K, Koller R, Isler C, Aytekin O, Al-Awami M, Meissl G, et al. Low Level Laser Therapy—a conservative approach to the burn scar? Burns. 2004;30(4):362-7. doi: 10.1016/j. burns.2003.12.012
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