Use of Therapeutic Lasers in Soft Tissue Surgery Cases

Laser therapy can be helpful in a variety of soft tissue conditions, such as wound healing (surgical incisions, flaps and grafts, infected wounds, ulcers), lick granuloma, moist dermatitis, panniculitis, saculitis, otitis, stomatitis, hygromas and others. Probably the most common use (and the most studied and reported one) is wound healing. The aim of the treatment is to speed up healing time, decrease the risk of seroma and dehiscence, prevent and fight wound infection, achieve a stronger and more malleable scar, decrease inflammation and help with pain management.

Several parameters have to be considered, such as wavelength (nm), dose or energy density (J/cm2), CW vs different frequencies (Hz), and average power (W). Class IV lasers include devices with an average power above 0.5W. It is recommended to use a Class IV laser to treat broad areas or with high dosages in a clinically reasonable treatment time.

Wavelength determines the chromophores that are stimulated and the depth of penetration. Acute wounds are treated with lower dosages (1-4 J/cm2) while chronic ones sometimes may need up to 25 J/cm2. Soft tissue protocols often include a combination of CW and mid to high frequencies (500 to 20.000 Hz). 1-4W of average power are used on the skin, while 3-10W may be used to treat deeper structures.

Acute conditions can be treated daily for 2-3 days (or even twice a day initially), then every 48h 2-3 times, then every 48-72h until the condition is resolved. If the treatment schedule cannot be such, 1-3 treatments are often enough to clinically change the healing process. Chronic conditions can be evaluated 24h after the first treatment to check if the initial dose as elicited any response or needs to be increased, and then treated every 48-72h until resolution. Treatments should no be spaced apart until some improvement is noted.  [...]