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Effects of low-power light therapy on wound healing: LASER x LED 621 ble to apply a very small amount of light to produce clinically significant effects on tissues.92 In short, light absorption depending on the wavelength, causes primary reactions on the mito- chondria. These are followed by a cascade of second- ary reactions (photosignal transduction and amplifi- cation) that occur in the cytoplasm, membrane and nucleus as shown by the Karu model (Figure 3). Source: Huang YY, et al. 2009. FIGURE 3: Karu Model 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.93 Sources like LASER differ from LED ones because of a characteristic known as coherence. This feature is related to stimulated emission mechanisms, with LASER light being formed by same frequency, REFERENCES 1. Cesaretti IUR. Processo fisiológico de cicatrização da ferida. Pelle Sana. 1998;2:10-2. 2. Borges EL. Fatores intervenientes no processo de cicatrização. In: Borges EL, Saar SRC, Lima VLAN, Gomes FSL, Magalhães MBB. Feridas: como tartar. Belo Horizonte: Coopmed; 2001. 3. Mandelbaum SH, Di Santis EP, Mandelbaum MHS. Cicatrização: conceitos atuais e recursos auxiliaries - Parte II. An Bras Dermatol. 2003;78:525-42. 4. Poltawski L, Watson T. Transmission of therapeutic ultrasound by wound dres- sings. Wounds. 2007;19:1-12. 5. Cutting KF. Electric stimulation in the treatment of chronic wounds. Wounds. 2006;2:62-71. 6. Brem H, Kirsner RS, Falanga V. Protocol for the successful treatment of venous ulcers. Am J Surg. 2004;188:1-8. 7. Mester E, Juhász J, Varga P, Karika G. Lasers in clinical practice. Acta Chir Acad Sci Hung. 1968;9:349-57. 8. Yeh NG, Wu C, Cheng TC. Light-emitting diodes - their potential in biomedical applications. Renew Sust Energ Rev. 2010;14:2161-6. 9. Lubart R, Wollman Y, Friedmann H, Rochkind S, Laulicht I.. Effects of visible and near infrared lasers on cell cultures. J Photochem Photobiol B. 1992;12:305-10. 10. Yu W, Naim JO, Lanzafame RJ. Effects of photostimulation on wound healing in diabetic mice. Lasers Surg Med. 1997;20:56-63. direction and phase waves.94 Some authors believe that coherence plays a role in the production of light therapy derived benefits, and LED (not coherent) would be less efficient than LASER (coherent) or even unable to promote therapeutic effects.95 The reviewed studies, however, have shown that LED light can be as effective as LASER, since both have similar biological effects, with no significant dif- ference between them. The cellular response to photo- stimulation is not associated with specific properties of LASER light, such as coherence.96 According to Karu, the property of coherence is lost during the interaction of light with biological tissue, not being thus a prerequisite for the process of photostimulation or photoinhibition.86 More clinical studies, especially with LEDs, must be performed in order to assess the adequacy of param- eters commonly used experimental in vitro and animal studies to the clinical practice, since, in the relevant lit- erature, there is a diversity in methodology, as well as differences in wavelength, dose and types of study. CONCLUSION The reviewed studies show that phototherapy, either by LASER or LED, is an effective therapeutic modality to promote healing of skin wounds. The bio- logical effects promoted by these therapeutic resources are similar and are related to the decrease in inflamma- tory cells, increased fibroblast proliferation, angiogen- esis stimulation, formation of granulation tissue and increased collagen synthesis. In addition to these effects, the irradiation parameters are also similar between LED and LASER. Importantly, the biological effects are dependent on such parameters, especially wavelength and dose, highlighting the importance of determining an appropriate treatment protocol. q 11. Almeida-Lopes L, Rigau J, Zângaro RA, Guidugli-Neto J, Jaeger MM. Comparison of the low-level laser therapy effects on cultured human gingival fibroblasts proli- feration using different irradiance and same fluence. Lasers Surg Med. 2001;29:179-84. 12. Reddy GK, Stehno-Bittel L, Enwemeka CS. Laser photostimulation accelerates wound healing in diabetic rats. Wound Repair Regen. 2001;9:248-55. 13. Pereira AN, Eduardo Cde P, Matson E, Marques MM. Effect of low-power laser irra- diation on cell growth and procollagen synthesis of cultured fibroblasts. Lasers Surg Med. 2002;31:263-7. 14. Medrado AR, Pugliese LS, Reis SR, Andrade ZA. Influence of low level laser thera- py on wound healing and its biological action upon myofibroblasts. Lasers Surg Med. 2003;32:239-44. 15. PuglieseLS,MedradoAP,ReisSR,AndradeZdeA.Theinfluenceoflowlevellaser therapy on biomodulation of collagen and elastic fibers. Pesqui Odontol Bras. 2003;17:307-13. 16. Reddy GK. Comparison of the photostimulatory effects of visible He-Ne and infra- red Ga-As lasers on healing impaired diabetic rat wounds. Lasers Surg Med. 2003;33:344-51. 17. Byrnes KR, Barna L, Chenault VM, Waynant RW, Ilev IK, Longo L, et al. Photobiomodulation improves cutaneous wound healing in an animal model of type II diabetes. Photomed Laser Surg. 2004;22:281-90. Light absorption (primary reactions) Photosignal transduction (secondary reactions) Photobiological response Light Mitochondria Cytoplasm Nucleus (DNA/RNA synthesis) Na+, K+, Ca++: Na+ (sodium), K+ (potassium), Ca++ (calcium) An Bras Dermatol. 2014;89(4):616-23.PDF Image | Effects of low-power light therapy on wound healing
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