1998 年 10 巻 3 号 p. 123-128
Persistent skin ulcers are still a major problem for the plastic and reconstructive surgeon. These ulcers of various aetiologies are often resistant to conventional therapeutic methodologies, and present both patient and surgeon with severe problems. Low level laser therapy (LLLT) has been proved to accelerate wound healing by enhancing blood flow, macrophage activity and lymphatic drainage in the inflammatory stage; by increasing fibroblast proliferation and collagen deposition in the proliferative stage; by encouraging more fibroblast to myofibroblast transformation in the contractile stage; and by assisting with remodelling in the final stage of repair. It was considered that these LLLT-associated actions, coupled with others, would be of assistance in treating persistent ulcers in a painless, side-effect free and noninvasive manner. The laser used was a near infrared 830 nm gallium aluminium arsenide (GaAlAs) semiconductor laser delivering 150 mW in continuous wave. The laser was applied in the contact mode for 15 to 30 sec per point, irradiating the intact skin around the periphery of the ulcer. The incident energy density was approximately 66 J/cm2 or 132 J/cm2 per point, depending on the exposure time. Nine representative case reports are presented of persistent therapy-resistant ulcers of a variety of aetiologies which responded very well to 830 nm diode LLLT. Although further research is needed to elucidate completely the mechanisms and pathways of LLLT in wound healing enhancement, enough has been scientifically proved to date to justify the application of LLLT for persistent ulcers as a safe, effective, painless and side effect free modality, particularly when used as an adjunctive therapy together with good wound care.
