wIRA for experimental wounds
the University Medical Center Charité
Berlin, Department of Dermatology
In a prospective, randomized, controlled study with 12 volunteers at the University Medical Center Charité, Berlin, Germany, volunteers were inflicted with 4 experi-mental superficial wounds (5 mm diameter). In this acute wound model, wounds were generated by a suction cup technique, with the roof of the blister being removed with a scalpel and sterile forceps (day 1). 4 different treat-ments were used and investigated over 10 days: no therapy, wIRA(+VIS) only (approximately 75% wIRA, 25%VIS; 30 minutes irradiation once a day), only dexpanthenol (= D-panthenol) cream once a day, wIRA(+VIS) and dex-panthenol cream once a day. Healing of the small experimental wounds was, from a clinical point of view, excellent with all 4 treatments. Therefore there were only small differences between the treatments with slight advan-tages seen with the combination wIRA(+VIS) and dexpan-thenol cream and with dexpanthenol cream alone as far as relative change of wound size and assessment of feeling of the wound area were concerned.
Laser scanning microscopy, however, together with a scoring system revealed differences between the 4 treatments concerning the formation of the stratum corneum (from first layer of corneocytes to full formation) especially on days 5–7: the fastest formation of the stratum corneum was seen in wounds treated with wIRA(+VIS) and dexpanthenol cream, second was wIRA(+VIS) alone, third dexpanthenol cream alone and lastly, untreated wounds. Bacterial counts of the wounds (taken every 2 days) showed that wIRA(+VIS) and the combination of wIRA(+VIS) with dexpanthenol cream were able to inhibit the colonisation with physiological skin flora up to day 5 when compared with the two other groups (untreated group and group with dexpanthenol cream alone). At any investigated time, the amount of colonisation under therapy with wIRA(+VIS) alone was lower (interpreted as being more suppressed) compared with the group with wIRA(+VIS) and dexpanthenol cream .
Figure 10: Relative change of wound area in severely burned children as a function of duration of treatment (in days) in the group with water-filtered infrared-A (wIRA) and visible light (VIS) and in the control group with only visible light (VIS)
(given as minimum, percentiles of 25, median, percentiles of 75, and maximum (box and whiskers graph with the box representing the interquartile range), adapted from ). The figure presents the data from those 10+10 = 20 children (out of 21+24 = 45 children), who had second degree, type a burns (not second degree, type b burns) and were consequently treated non-surgically until complete cutaneous regeneration occurred including irradiation (starting on the day of the burn, until complete reepithelialization) with wIRA(+VIS) or with only VIS (control group). Patients in the group with wIRA showed a markedly faster reduction of wound area compared to the control group: a median reduction of wound size of 50% was reached in the group with wIRA already after 7 days compared to 9 days in the control group, a median reduction of wound size of 90% was achieved in the group with wIRA already after 9 days compared to 13 days in the control group.
Figure 11: Example of a rapid improvement with wIRA in a severely burned child (Study Kassel) Left: 1 day after the burn, right: only 30 hours later than shown on the left side (from ).
Figure 12: Example of a successful treatment of recurrent wound seromas with wIRA
A 64 year-old female patient had relapsing wound seromas and wound hematomas (without infection) after a hip operation
(replacement of the acetabulum part of a 15 year-old endoprosthesis) even after an additional operation with the sole intention of stopping the wound seromas and after approximately 8 aspirations of seroma fluid (up to approximately 90 mL within one aspiration) within 2 months, and a third operation was seriously considered: Figure A shows the sonographic state. At that time, wIRA(+VIS) irradiation was commenced, beginning with 30 minutes twice per day and increasing up to 3 times one hour per day. Within a few days the seroma no longer increased as usual; after approximately one week a slight decrease of seroma size was noticed clinically (Figure B). Figure C shows reduced seroma size after 18 days and Figure D after 29 days. After approximately 2 months the seroma had resolved completely (both clinically and sonographically) without any aspiration of seroma fluid or operation since commencement of wIRA(+VIS) irradiation (sonographic pictures published with kind approval of Dr. Michael Paulus, Herzogenaurach, Germany) (from ).