Schindl M, Kerschan K, Schindl A, Schön H, Heinzl H, Schindl L
Institute for Laser Medicine, Vienna, Austria.
Photodermatol Photoimmunol Photomed. 1999 Feb;15(1):18-21. doi: 10.1111/j.1600-0781.1999.tb00047.x.
Chronic skin ulcers still represent a therapeutic challenge in dermatology. Among the various non-invasive treatment modalities used for the improvement of impaired wound healing, low-intensity laser irradiations are gaining an increasing body of interest. We used low-intensity laser irradiations delivered by a 30 mW helium-neon laser at an energy density of 30 J/cm2 three times weekly for the induction of wound healing in ulcers of diverse causes. Twenty patients with the same number of ulcers, which had previously been treated by conventional wound care for a median period of 34 weeks (range: 3-120 weeks) without any significant evidence of healing, were included in the study. Concerning the underlying disorders, patients were divided into four groups: diabetes, arterial insufficiency, radio damage and autoimmune vasculitis. In all ulcers, complete epithelization could be induced by laser therapy. No amputation or any other surgical intervention was necessary and no adverse effects of any kind were noted during low-intensity laser treatment. Regarding the different diagnoses, a statistically significant difference was noted (P = 0.008): ulcers due to radio damage healed significantly faster than those caused by diabetes (6 weeks [range: 3-10 weeks] vs. 16 weeks [range: 9-45 weeks], P = 0.005). Wound healing in autoimmune vasculitis (24 weeks [range: 20-35 weeks]) required longer than in radiodermitis, although the difference was not significant. In addition to the diagnosis, wound size was found to be an important factor influencing the duration of wound closure (P = 0.028), whereas duration of previous conventional treatment (P = 0.24) and depth (P = 0.14) showed no effect. Our results indicate that low-intensity laser irradiation could be a valuable non-invasive tool for the induction of wound healing in recalcitrant ulcers, and that healing time is correlated with the ulcer cause and size.
慢性皮肤溃疡仍是皮肤科治疗中的一项挑战。在用于改善伤口愈合受损的各种非侵入性治疗方式中，低强度激光照射正越来越受到关注。我们使用一台30毫瓦的氦氖激光以30焦/平方厘米的能量密度每周三次进行低强度激光照射，以促进各种原因所致溃疡的伤口愈合。本研究纳入了20例患者，他们的溃疡数量相同，这些溃疡此前接受传统伤口护理的中位时间为34周（范围：3 - 120周），但均未出现明显愈合迹象。关于潜在疾病，患者被分为四组：糖尿病、动脉供血不足、放射性损伤和自身免疫性血管炎。在所有溃疡中，激光治疗均可诱导完全上皮化。无需截肢或进行任何其他手术干预，且在低强度激光治疗期间未观察到任何不良反应。关于不同诊断，发现存在统计学显著差异（P = 0.008）：放射性损伤所致溃疡的愈合速度明显快于糖尿病所致溃疡（6周[范围：3 - 10周] vs. 16周[范围：9 - 45周]，P = 0.005）。自身免疫性血管炎患者的伤口愈合（24周[范围：20 - 35周]）所需时间比放射性皮炎患者长，尽管差异不显著。除诊断外，发现伤口大小是影响伤口闭合时间的重要因素（P = 0.028），而先前传统治疗的持续时间（P = 0.24）和深度（P = 0.14）未显示出影响。我们的结果表明，低强度激光照射可能是促进顽固性溃疡伤口愈合的一种有价值的非侵入性工具，且愈合时间与溃疡病因和大小相关。
