The Blue Wound
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Furthermore, the use of LED as a therapeutic resource remains controversial. There are questions regarding the equality or not of biological and therapeutic effects promoted by LED and LASER resources, but also regarding the appropriate parameters to each of these light sources. This study aimed to determine, through a literature review: 1 - the biological effects that support the use of light sources such as LED in the treatment of wounds and 2 - the light parameters wavelength and dose suitable for the treatment of wounds with LED light sources.
The biological effects and light parameters of LED will be compared to those of LASER in order to verify the similarity or not regarding wound treatment. The literature search was restricted to studies published in English and Portuguese in the period of The keywords used were "low level laser therapy", "laser", "light emitting diode", "LED", "phototherapy", "wound healing", "fibroblast", "collagen" and "angyogenesis" combined with each other.
According to data presented on table 1 , 16 of the 48 studies on the effects of LASER light were in vitro and 32 were performed in animals. Doses ranging from 0.
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One study did not cite the dose value used. Eight of the 14 studies on the effects of LED light were in vitro studies and 6 performed in animals, as shown in table 2. Doses ranged from 0. However, not all studies reported the dose applied. Since the introduction of photobiomodulation in healthcare, the effectiveness and applicability of light resources for the treatment of skin wounds have been extensively investigated both in vitro and in vivo. Nevertheless, the biological mechanisms that support the actions of low intensity light in tissues are still not clearly elucidated.
While some studies report an increase in cellular proliferation of several cell types including fibroblasts, endothelial cells and keratinocytes, conflicting results about the clinical benefits of using light on skin wounds are found in the literature. The way light interacts with the biological tissues will depend on the characteristics and parameters of light devices, mainly the wavelength and dose, and also the optical properties of the tissue.
Regarding the characteristics of light devices, LASER consists of a resonant optical cavity and different types of active media such as solid, liquid or gaseous materials, in which processes of light generation occur through the passage of an electric current. On the other hand, LED is a diode formed by p-n junctions p-positive, n-negative that, when directly polarized, causes electrons to cross the potential barrier and recombine with holes within the device.
After the spontaneous recombination of electron-hole pairs, the simultaneous emission of photons occurs. The physical mechanism by which LED emits light is spontaneous light emission. The light-emitting diodes convert the electrical current in a light spectrum, a process called electroluminescence. The variable characteristics and parameters of light devices is one of the factors that complicate the interpretation of research results about the effects of low intensity light on skin wounds.
As observed in this study, there is discordance between the types of light and parameters used in studies. This fact may limit the decision-making process regarding the role of light in treating wounds since photobiomodulator effects are parameter-dependent. Light absorption is dependent on wavelength and the main tissue chromophores hemoglobin and melanin strongly absorb wavelengths shorter than nm.
For these reasons, there is a therapeutic window in the optical spectral range of red and near infrared, wherein the efficiency of light penetration in the tissue is maximum Figure 1. Fifty-nine of the 68 studies reviewed applied LASER or LED inside the optical therapeutic window and 9 applied them in the range of blue or green, and even so biological effects were observed.
Although light in the blue and green wavelengths range can achieve significant effects in cells, the use of low power light in animals and humans involves almost exclusively light in red and near infrared wavelengths. The most significant biological effects were seen with predominant dose values, i. According to Sommer et al, very low doses do not promote biological effects, while higher doses result in inhibition of cellular functions. The mechanism of light action on the cellular level that supports its biological effects is based on photobiological reactions.
A photobiological reaction involves the absorption of a specific wavelength of light by photoreceptor molecules. There is evidence that wavelengths in the spectral range from red to near infrared are absorbed by cytochrome c oxidase. In addition, they also observed the absorption by cytochrome c oxidase in these four bands. The authors concluded that cytochrome c oxidase could absorb light in different spectral bands red and near infrared , probably in the binuclear centers CuA and CuB oxidized forms.
Photobiological reactions can be classified into primary and secondary. Primary reactions derive from the interaction between photons and the photoreceptor, and they are observed in a few seconds or minutes after the irradiation of light.
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On the other hand, secondary reactions are effects that occur in response to primary reactions, in hours or even days after the irradiation procedure. The primary reactions of light action on photoreceptors are not yet clearly established, but there are some hypotheses. After the absorption of light in the irradiated wavelength, cytochrome c oxidase displays an electronically excited status, from which it alters its redox status and causes the acceleration of electron transfer in the respiratory chain. The mechanism of secondary photobiological reactions is determined by transduction energy transfer from one system to another and photosignal amplification leading to photoresponse.
This means that effects derived from primary reactions are amplified and transmitted to other parts of the cell, resulting in physiological effects such as alterations in cell membrane permeability with changes in intracellular calcium levels, increased cellular metabolism, DNA and RNA syntheses, fibroblast proliferation, activation of T lymphocytes, macrophages and mast cells, increased synthesis of endorphins and decreased bradykinin.
Secondary reactions are responsible for the connection between response to light action by photoreceptors located inside the mitochondria and the effects located in the nucleus or different phenomena in other cell components. This process makes it possible to apply a very small amount of light to produce clinically significant effects on tissues. In short, light absorption depending on the wavelength, causes primary reactions on the mitochondria. These are followed by a cascade of secondary reactions photosignal transduction and amplification that occur in the cytoplasm, membrane and nucleus as shown by the Karu model Figure 3.
Nevertheless, there is a hypothesis about a modification in the Karu model. It is believed that the red light is absorbed by cytochrome-c oxidase inside the mitochondria, while the infrared wavelength is absorbed by specific cell membrane proteins directly affecting membrane permeability; both pathways lead to the same photobiological end response.
This feature is related to stimulated emission mechanisms, with LASER light being formed by same frequency, direction and phase waves. The reviewed studies, however, have shown that LED light can be as effective as LASER, since both have similar biological effects, with no significant difference between them.
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The cellular response to photostimulation is not associated with specific properties of LASER light, such as coherence. More clinical studies, especially with LEDs, must be performed in order to assess the adequacy of parameters commonly used experimental in vitro and animal studies to the clinical practice, since, in the relevant literature, there is a diversity in methodology, as well as differences in wavelength, dose and types of study. The biological effects promoted by these therapeutic resources are similar and are related to the decrease in inflammatory cells, increased fibroblast proliferation, angiogenesis stimulation, formation of granulation tissue and increased collagen synthesis.
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Importantly, the biological effects are dependent on such parameters, especially wavelength and dose, highlighting the importance of determining an appropriate treatment protocol. Cesaretti IUR. Pelle Sana. Borges EL. Feridas: como tartar. Belo Horizonte: Coopmed; An Bras Dermatol. Poltawski L, Watson T.
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Transmission of therapeutic ultrasound by wound dressings. Cutting KF. Electric stimulation in the treatment of chronic wounds. Protocol for the successful treatment of venous ulcers. Am J Surg. Lasers in clinical practice.
Acta Chir Acad Sci Hung. Light-emitting diodes - their potential in biomedical applications.
Renew Sust Energ Rev. An area of particular interest and success at the Comprehensive Wound Healing Center is in the treatment of infections involving bones or tendons. Using a combination treatments including hyperbaric oxygen therapy and FDA-approved Manuka Honey, many of these hard to heal wounds have gotten better. For more information or to make an appointment, call the Comprehensive Wound Healing Center at Back to Medical Services List.
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