CO2 Laser for Chronic Wound Healing

A recent study in Lasers in Surgery and Medicine (LSM), the official journal of the American Society for Laser Medicine and Surgery (ASLMS) examined the efficacy of using ultrapulsed CO₂ laser debridement versus traditional surgical debridement to treat chronic wounds.

The study randomly divided patients into two groups. One group (28 wounds) received laser debridement and the other (26 wounds) surgical debridement. Wound healing, wound infection control, and wound changes in blood perfusion were compared.

Chronic wounds were defined as full‐thickness wounds with an initial diagnosis and treatment (including primary disease treatment and nutritional treatment) and regular changing of dressings, with a duration of wound healing lasting more than 6 weeks.

In both groups, wounds were cleaned with saline and the wound surface and periwound skin were disinfected using iodophor. In the instrument/surgical debridement group, the bacterial biofilm and remaining necrotic/aging tissue was removed with scissors, tweezers or a scalpel, and the wound surface was wiped with sterile gauze to remove any remaining substances.

In the laser debridement group, patients were treated with an ultrapulsed CO₂ Laser (ML-2030CI; Wuhan Miracle Laser Technology Co., Ltd., Wuhan, China) in de-focused continuous mode for four to six seconds, according to the study. The amount of energy used during treatment ranged from 60 MJ to 140 MJ, depending on the patient’s wound conditions. High energy vaporization was used in cases with excessive necrotic tissue or aging granulations. Carbonized wound tissues were cleared with an iodophor cotton swab and debridement was repeated until achieving healthy tissue.

Prior to each debridement, the size of the wound for patients in both groups were measured using a three-dimensional wound measurement device (eKare insight, eKare; Fairfax, Va.) and pictures were taken. Wound healing rates were calculated at 7, 14, 21, and 28 days post-treatment, according to the study. The time required to achieve complete wound healing was also reported.

Study findings show that the use of CO₂ laser debridement resulted in a higher wound healing rate and a significantly lower positive bacterial culture at 14 and 28 days after the treatment, compared to the other patient group.

Study authors suggest that these findings demonstrate the efficacy of ultrapulsed CO₂ laser for a more precise and thorough debridement. However, they also note that the treatment is time consuming, laborious and uneconomical for treating large or highly necrotic wounds.

While more investigation is needed, study authors agree that the use of CO₂ laser debridement can more effectively decrease wound infection rate, promote an increase in wound blood perfusion, and achieve faster wound healing compared to the traditional instrument/surgical debridement.

References:

Jiang B, Tang R, Zheng D, et al. Evaluation of the Efficacy of Ultrapulsed CO Laser in Chronic Wounds. Lasers Surg Med. 2020; https://doi.org/10.1002/lsm.23283