Bedsores, or ulcers, are lesions of the skin and of the deeper tissues (caused by the pressure for a substantial period), which reduces or, in severe cases, stops the blood flow in the affected area. The most of the people who are affected by this disease, and also those most at risk, are undoubtedly the disabled in wheelchairs and bedridden who have to maintain the same position constantly. The former could develop this problem in the area of the gluteus, shoulder blades and back of the thighs, the latter could develop bedsores from the neck to the foot (heel and toes) in all the areas that are in constant contact with the bed.
Bedsores usually have a fast progression and are often difficult to cure. The National Pressure Ulcer Advisory Panel has categorized them according to four stages:
Stage I: bedsore appears as an area characterized by a diffuse redness, which may itch, hurt or give a feeling of warmth or swelling.
Stage II: The skin lesions appear to the deepest part of the epidermis (the dermis). The wound is open and has the appearance of a bladder or an abrasion.
Stage III: When the bedsore has reached this stage, the lesion has spread to subcutaneous tissue, creating a wound that looks like a deep cavity.
Stage IV: It is the most serious and advanced stage. Necrosis occurs on a large scale of the skin; the muscles, skin and support structures such as tendons and joints are deeply damaged.
The first stage wound is the easiest to treat and, in most cases, gets better after removing the pressure on the affected area. The other stages are more problematic and, especially III and IV stages should be treated with great attention, reducing the pressure in the affected area with appropriate supports and maintaining a perfect hygiene (in urinary incontinence cases it is necessary to protect the wound from bacterial contamination with special adhesive films).
The therapeutic approach to delayed healing ulcers is still a challenge for the rehabilitation medicine in which, together with conservative therapy and pharmacology, also the high power laser 1064 nm has established a good reputation. Several studies have indeed shown that it is possible, in timeframes ranging from 4 to 8 weeks, to get a visible reduction of the WSA (Wound Surface Area) until complete healing, even in difficult cases of ulcers.
Healing (photochemical) effect: The laser (1064 nm) is able to stimulate mitochondrial activity by promoting cell proliferation and migration, production of collagen (proteins and RNA) and transition from ADP to ATP. Then it acts on mitochondria triggering mechanisms of cellular repair.
Anti-edemigeno (photomechanical) effect: The laser beam exerts a micro-massage that helps to reactivate microcirculation and lymphatic drainage. In this way it is favored the oxygenation of tissues, it is facilitated the drainage of inflammatory molecules, it is stimulated the removal of collected liquid. There is a rapid and intense anti-inflammatory and anti-edemigeno effect.
Photothermal effect: The laser causes a controlled increase of the temperature of tissues, stimulating the circulation with a consequent increase in oxygen supply to the suffering structures.
Thanks to its effects, the laser 1064 nm, as the Crystal Yag is, leads to good results in the treatment of bedsores allowing to penetrate the tissues in depth (up to 5cm) by giving a lot of energy without having an excessive temperature increase and thereby reactivating microcirculation in the area affected by the disease.