by Kate Parsons MSCP. ACPAT Cat A. RCH Dip. and Katy Roberts MSCP. ACPAT Cat A.

CASE HISTORY

Use of Low level laser therapy (LLLT - red) on a dog with previous history of wound breakdown and multiple allergies.

Summary:

Referral to physiotherapy is appropriate for wound management. Difficult wounds that are not responding to conventional dressings and antibiotics can be treated successfully by adding laser therapy. This treatment is commonly used by physiotherapists.

Keywords:

Wound breakdown, LLLT, promotion of healing.

Introduction:

Innis, a 15 month old Irish Wolfhound started life with the usual breed standard long, magnificent tail. Sadly, he developed a range of allergies causing skin irritation and he responded by gnawing at his tail, necrosis of the tail followed and he underwent a partial amputation of tail in December 2015. The wound quickly broke down and the only way forward was to perform a full stump amputation of the tail in January 2016. Due to his previous history of wound breakdown Innis was given a course of antibiotic therapy and was referred to FootFalls Canine Physiotherapy Services for immediate wound management with LLLT.

Clinical History:

  • Innis, 15 month old Irish Wolfhound.
  • Multiple allergies causing skin irritation.
  • Previous partial amputation of tail failed, stump amputation performed 24th January 2016.
  • Physiotherapy assessment and Treatment 1 including cleaning and redressing of wound 29th January 2016.
  • 12 LLLT sessions given over 6 week period.
  • Chattanooga Intellect Vet Combi clinical protocols for acute wounds were used.
  • 2 x 7 minutes single LED 10ww, 670 nm, 8Hz frequency, low pulse, 5.4J/ cm²
  • Potential wound breakdown noted on 5th February 2016, slight smell and small area of redness and sloughing – vet consulted, swabs taken and change of antibiotics made due to the presence of e coli. No further deterioration of wound.

Photos:

Week 1: Dressing intact, no seepage. Sutures in place. Wound left open and cleaned with 1/10 hibiscrub solution.

Week 2: Small sloughy area to right side of wound. Head turn when cleaned and redressed. Vet consultation, wound smelling, antibiotics changed, swab shows e coli infection.

Week 3: Wound looks healthy and pink.

Week 4: Wound clean and dry, sutures still in place.

Week 5: Wound looks healthy. Scab almost fallen off.

Week 6: Sutures removed, some redness along scar line but healing well. Hair growing back. Wound dry.

Week 7: Wound completely healed. Discharged.

Back in the show ring: May 2016. Owners reported comments from judges that Innis had actually improved in gait and balance.

Discussion:

LLLT has been in use for the promotion of wound healing in humans since the 1960s. A meta analysis of the available literature relating to its use in 2004 reviewed 24 studies, including a sub analysis of the effects in animals. It was found that the overall effect of LLLT on wound healing was highly significant. The analysis concluded that LLLT had a positive effect on inflammation, augmentation of collagen synthesis increasing tensile strength and reducing healing times. (Woodruff et al 2004).

Kate Parsons

There are three phases of wound healing – inflammation, tissue formation and tissue remodelling. This is a dynamic and interactive process and the phases overlap in time. It is well documented that the use of LLLT promotes wound healing, reduces pain and inflammation, increases collagen deposition and accelerates wound closure. (Kilik, Lakyova, 2014) The exact mechanism and parameters are not yet fully clarified and there is considerable variation in treatment modalities. De Silva (2010) concluded that LLLT speeds up the process of tissue repair but added that more studies were required to determine best parameters for treatment modalities. However, various studies into the use of LLLT have concluded that it does confer a protective effect against excessive inflammatory tissue response, stimulates neovascularisation and the early formation of collagen fibres. Antibiotic therapy is often indicated and forms an important role in wound management; however, being systemic, has recognised side effects as well as the increasing problem of drug-resistance in wound management (Rashidi et al 2015).

LLT has been found to inactivate bacteria. This is thought to be caused by the denaturing of proteins and also effects on the cell wall. Bacteria, being oxygen dependent, is inactivated in part due to photoexcitation of porphyrins that are thought to act as endogenous photosensitizers with the bacteria itself (Percival et al 2015.

Katy Roberts

A more recent study by Kurach, Stanley et al (2015) found no apparent benefits on the healing of acute wounds using dual diode (7.5mh / diode @ 635nm and total energy density 1.125 J/cm²). The treatment modality for Innis (see above) was pre set in the equipment for much higher doses of LLLT and, as can be seen from the photographic diary of the healing process, has been successful.

Conclusion:

Whilst the successful treatment of one dog is not conclusive evidence that LLLT is always effective, it appears that it can contribute to the healing of problematic wounds. Other variables such as antibiotic therapy and good wound management must also play a part, however, in comparison to the previous experience of wound breakdown necessitating further full amputation of the tail it can be suggested that early referral to physiotherapy post operatively for the management of wounds, and the inclusion of LLLT has perhaps made the difference to Innis this time.

REFERENCES:

Woodruff L.D; Bounkeo J.M; Brannon W.M; Dawes K.S; Barham C.D; Waddell D.L; Enwemeka C.S. (2004) The Efficacy of Laser Therapy in Wound Repair: A Meta-Analysis of the literature. Photomedicine and Laser Surgery. Vol. 22. Issue 3. 241 – 247.

Yasukawa A; HRUI H; Koyama Y; Nagai M; Takakuda K (2007) The Effect of Low Reactive Laser Therapy with Helium – Neon Laser on Operative Wound Healing in a Rat Model. Journal Veterinary Medical Science. Vol 69. No 8. 799 – 806.

De Silva. (2010) Literature Review: Laser Treatment in the tissue repair process. Photomedical Laser Surgery. 2010. p.17 – 21.

Kilik R; Lakyova L. (2014) Effect of equal daily doses achieved by different power densities of LLLT at 635mn on open skin wound healing in normal and diabetic rats. Biomedical Research International. Vol 2014. Art ID: 269253.

Kurach C; Stanley B; Gazzola K; Fritz M; Steficek B; Hauptman J.G; Seymour K.J (2015) The Effect of LLLT on healing of open wounds in dogs. Veterinary Surgery. Vol 44. Issue 8. 988 – 996.

Lucroy M.D; Edwards B.F; Madewell B.R. (1999) Low-intensity Laser Light-Induced Closure of Chronic Wound in a Dog. Veterinary Surgery. Vol 28; Issue 4; 202 – 295.

Percival, S.L., Francolini, I. and Donelli, G., 2015. Low-level laser therapy as an antimicrobial and antibiofilm technology and its relevance to wound healing. Future microbiology, 10(2), pp.255-272.

Rashidi, S., Yadollahpour, A. and Mirzaiyan, M., 2015. Low Level Laser Therapy for the Treatment of Chronic Wound: Clinical Considerations. Biomedical and Pharmacology Journal, 8(2), pp.11211127.

 

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