[The effectiveness of combined laser therapy in patients with trophic leg ulcer and chronic venous insufficiency]. / Effektivnost' kombinirovannoi lazernoi terapii patsientov s troficheskimi yazvami nizhnikh konechnostei na fone khronicheskoi venoznoi nedostatochnosti.

New prospects associated with the use of laser radiation of different wavelengths in the ultraviolet (365 nm) and the green emission spectrum (525 nm) have appeared in recent years. The high prevalence of the trophic leg ulcers necessitates the search for more effective methods of conservative treatment. PURPOSE OF THE STUDY: Development and scientific justification for the low-intensity laser radiation of different wavelengths combined use in patients with trophic leg ulcers and chronic venous insufficiency (CVI). MATERIAL AND METHODS: 102 patients with trophic leg ulcers and CVI were examined. They were divided into 3 equal groups using simple randomization. Patients in the control group received only traditional conservative therapy; comparison group - traditional conservative therapy and an intravenous laser blood irradiation (ILBI) (λ - 635 nm); the main group - traditional conservative therapy and different wavelengths laser therapy (LT) course. RESULTS AND CONCLUSION: A more significant improvement in the clinical condition occurred under the influence of the course application of combined different wavelengths laser therapy in patients with trophic venous leg ulcers. Compared to patients who received traditional conservative therapy and in combination with ILBI 635 nm, the speed of reparative regeneration of trophic ulcers increased, the time for cleansing trophic ulcers from devitalized tissues was reduced. Computer capillaroscopy data showed that the positive effect of laser exposure on all parts of the microcirculation underlies its therapeutic efficacy.

[The application of combined low-intensity laser therapy for the treatment of the patients presenting with trophic ulcers associated with chronic venous insufficiency of the lower extremities]. / Kombinirovannaia lazernaia terapiia v lechenii patsientov s troficheskimi iazvami nizhnikh konechnostei.

AIM: The objective of the present study was the evaluation of the effectiveness of the combined treatment of the patients presenting with trophic ulcers associated with chronic venous insufficiency of the lower extremities of venous etiology with the application of low-intensity laser therapy (LILT) at different wavelengths. MATERIAL AND METHODS: The study included the patients presenting with chronic venous insufficiency (CVI) (class C6 in accordance with the CEAP clinical classification). The ultrasonic Doppler examination (USDG) of the lower extremities revealed valvular insufficiency in the saphenous veins in 98.8% of the examined patients, in the deep venous system in 58% of them, and in the perforating veins in 72% of the cases. The laser Doppler flowmetry technique was used to assess the state of the microcirculation. Group 1 was comprised of 34 (43.59%) patients undergoing the traditional conservative treatment that consisted of pharmacotherapy (including antibiotic therapy, depending on the sensitivity of microflora assessed by the culture technique), the local treatment in the form of dressing in compliance with the standard surgical treatment schemes depending on the phase of the wound healing process, and elastic compression of the lower extremities. The main group 2 consisted of 44 patients (56.41%) who were treated, in addition to the traditional conservative therapy, with the use of LILT according to the new technique that combines the external laser exposure of the trophic ulcer region using the 'LASMIK' laser device during a single 2 minute session per zone in the pulsed mode (light pulse duration of 100-130 ns, frequency 80 Hz), at a wavelength of 635 nm, by a matrix emitter (consisting of eight laser diodes with the surface area of 8 cm2), at a distance up to 7 cm, with pulsed power of 40 W, power density of 5 W/cm2, and the intravenous laser blood illumination (fiber output power 2 mW) with a wavelength of 365 nm (UV range) and 525 nm (green spectrum) alternately, every other day. Each patient underwent 12 daily procedures per course. RESULTS: Combined low-intensity laser therapy promoted the rapid recovery of the sympathetic regulation of the microvascular tone and normalization of arteriolar-venular relationships which contributed to the improvement of blood supply to the tissues, the reduction of inflammation, enhanced activation of the reparative processes, and acceleration of epithelialization of trophic ulcerous defects. CONCLUSION: The combined strategy makes it possible to carry out the more effective treatment of the patients presenting with trophic ulcers with the three-fold reduction of the ulcer healing time and the pronounced stimulation of the persistent adaptation of the physiological responses preventing the development of the relapses.