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Clinical observations have suggested that low-energy lasers might stimulate wound healing. To understand the mechanism of the biostimulation, we previously examined the effects of low-energy lasers on collagen production by human skin fibroblasts and reported an increase of collagen synthesis in vitro. To examine the effects of low-energy lasers in vivo, hairless mice were experimentally wounded, sutured, and subjected to laser irradiation by a helium-neon laser with a power output of 1.56 mW and an energy fluence of 1.22 Joules/cm2. Experimental wounds were subjected to laser treatment every other day for 2 months; control wounds remained untreated. Specimens from the wounds were then examined for histological findings, tensile strength, and total collagen content. Results demonstrated a considerable improvement in the tensile strength of the laser-irradiated wounds at 1 and 2 weeks. Furthermore, the total collagen content was significantly increased at 2 months when compared with control wounds. These results suggest a beneficial effect of the helium-neon laser on wound healing in vivo.

Pig skin was treated with the Nd:YAG laser at 1,060 nm or electrocautery, at energy densities of 649 +/- 20 J/cm2 and 612 J/cm2, respectively. Biopsies of treated areas and of normal skin were performed at 7, 14, and 60 days after treatment and processed for histology, electron microscopy and biochemical assays. Wound healing, as shown histologically, was similar in both treated groups. Depth of injury appeared to reach reticular dermis at day 7 in each treated group. However, thermal burn was more destructive of regular collagen, whereas the laser appeared to damage deep dermal blood vessels without destroying surrounding connective tissue. Biochemical assays revealed increased collagen production and increased collagenolytic activity 7 days after laser injury. However, by day 60, there was a reduction in total collagen content in laser treated skin below that of normal skin, which correlated with decreased collagen synthesis and unchanged collagenolytic activity. In burn specimens there was an initial decrease in total collagen content which reverted to normal by day 60. Active collagen degradation occurred at all 3 time points, but a marked increase in synthetic activity occurred as the burn scar was laid down. Laser treatment resulted in reduction of the amount of collagen below that in burn scarred or normal skin, suggesting that classical scar formation may be inhibited. These results indicate that the Nd:YAG laser may be useful for the treatment of keloids and hypertrophic scars.

Human skin fibroblasts were subjected to treatment with a Neodymium:YAG laser at 1060 nm with varying levels of energy determined by a reproducible method of dosimetry. DNA synthesis in the cells was measured by the incorporation of [3H]thymidine, and collagen production was monitored by the synthesis of nondialyzable [3H]hydroxyproline after incubation of cells with [3H]proline. Using energy levels equal to 1.7 X 10(3) J/cm2, a significant reduction in DNA synthesis was noted, while the cells remained viable as tested by the trypan blue exclusion test. With energy levels higher or equal to 2.3 X 10(3) J/cm2, the suppression of DNA synthesis was accompanied by cell nonviability. The collagen production, when measured immediately following the treatment with 1.7 X 10(3) J/cm2, was markedly reduced, and similar effects were observed with higher energy levels. However, when the cells were tested for collagen production at 20 hours following laser treatment, there was a significant decrease in collagen production at energy levels as low as 1.1 X 10(3) J/cm2, a dose that did not affect DNA synthesis or cell viability. Thus, the results indicate that the Nd:YAG laser can selectively suppress collagen production without affecting cell proliferation. These observations suggest that laser treatment could potentially be used to reduce collagen deposition in conditions such as keloids and hypertrophic scars.

The use of lasers in medicine and surgery has increased slowly-its effectiveness based on trial-and-error clinical experience. Very little comprehensive data has been published that scientifically presents dosage, energy, absorption, and comparisons between types of lasers. Our laboratory has developed a method for taking the guesswork out of laser dosage using scientific data to optimize therapy and give reproducible responses. Experiments were conducted using an argon laser, a neodymium: YAG laser, and a broad-band infrared light source. This preliminary study uses a beam scan technique, which for the first time permits accurate measurement of the laser intensity incident on tissue. Therefore, this protocol allows the standardization of dosage measurements with good experimental reproducibility in biological models. By using this accurate method of measuring the intensity delivered to pigskin, we are able to reproduce for the first time similar histological damage with the different energy sources.