Abstract
It is my personal point of view that the most important aspect of the treatment of severe burns is to close the wound as quickly as possible, independently of the esthetics of the result. Several methods of treating burns may be found elsewhere on the literature, including the use of light sources. Over the past decade many papers have shown that some light sources, including laser light, are capable of improving the healing of several types of burns.
Knowledge, friendship, and respect are achieved through the accumulation of experiences over the years and are bound to be strengthened through respectful differences of opinion. Over the past years, I have been following the publication of several papers from Dr. Bayat's group from the Cellular and Molecular Biology Research Center, Medical of the Shahid Beheshti University, M.C., Tehran, Iran on both soft and hard tissue. I have not had the opportunity to meet Dr. Bayat, but we have discussed and exchanged experiences electronically.
In a recently published paper, Vasheghani et al. 1 suggested that pulsing may improve the healing of third degree burns treated with infrared (IR) laser light using a rodent model. Over the past five years, my research group and I have also studied the effects of both laser and polarized light on the healing of both second and third degree burns in non-systemically and systemically impaired animals. 2 –6 We have shown that parameters such as wavelength, dose, frequency of use, and others can influence the outcome of the healing of these burns. 7,8 However the effects of pulsing on burns has not been investigated up to now.
Despite the positive results found in the study, I am not completely aligned with the model used. Three burns were created and one was irradiated with the laser while the others acted as controls. Here, the systemic effect of laser light was disregarded. Rochkind et al. have nicely shown that systemic effects may not be disregarded clinically. 9 However, many others disagree with this and this is most probably related to the widely variable protocols used as well as the different assessment methods used in each study. This topic remains controversial. Even so, the results of this study clearly show a positive effect of the laser light.
Another point that seems very interesting was the choice of an IR wavelength. Most studies on soft tissues suggest that visible light exerts a more pronounced effect on cutaneous wounds than IR does. 7–8 Our experience allows us to say that on burns, lesions which deeply affect the tissues, IR wavelengths seem to be the better option as surface tissues are thermally damaged and less susceptible to be affected by the light. 2 –6 So, the use of a wavelength with deeper penetration associated with pulsing, which has been shown to increase penetration, may be accountable for the findings of this study. 10 We have found that the use of pulsed laser emitting, with both visible and non-visible wavelengths, positively affected the healing of burns. 3,6
Despite these differences of opinion, I respect and value the efforts of Dr. Bayat and his team to scientifically illustrate the positive effects of laser phototherapies on both hard and soft tissues and I do hope that someday in the near future we may work together.