Authors (including presenting author) :
Ko HL(1), Tam ST(1), Li YS(2)
Affiliation :
(1) Physiotherapy Department, Pok Oi Hospital (2) Wound Team, Pok Oi Hospital
Introduction :
Non-healing pressure injury has been one of the major reasons for prolonged hospitalization which increases the economic costs and burden to the healthcare system in managing patients due to the extended length of stay. Promoting wound healing leads to both reduced health expenditure and patient’s suffering from wound pain. There was a wide variety of treatments for pressure injury. In physiotherapy, one treatment approach has been widely discussed was phototherapy. There were many types of phototherapy used in physiotherapy including Low-level LASER Therapy (LLLT), infrared, visible or ultraviolet spectrum. The underlying mechanism of phototherapy was to induce photo-biostimulation which includes increasing cellular metabolism to enhance cell proliferation and granulation. Therefore, phototherapy was one of the possible non-pharmacological, minimally invasive and cost effective adjuncts to promote wound healing.
Objectives :
This article aims to share our experience on using phototherapy in treating one of the patient with prolonged unhealed infected pressure injury.
Methodology :
One patient (Patient X) with prolonged unhealed pressure injury was recruited during September to November 2022. Background of Patient X Patient X (87 years old, Male) was admitted for infected sacral sore on 15th August 22022. He was bedridden and cared by wife previously. The Norton scale of Patient X was 9 out of 20. After admission, he had received consultation and usual care from wound nurse. Negative pressure wound therapy (NPWT) was started since 21th September. His wound was considered as difficult to treat in view of having Diabetes Mellitus, multiple episodes of sepsis, sacral sore wound swab with culture of Gram negative bacilli(4 types) and Gram positive cocci（2 types）and therefore was referred to physiotherapy for wound management on 23th September. Phototherapy intervention Bioptron light therapy and LLLT were used alternatively during the treatment period. Protocol of phototherapy used were [1]Bioptron light therapy: 8-10minute each sessions and [2] LLLT: wavelength of 650nm, frequency of 5kHz, energy density 12J/cm2 using single probe non-contact scanning method with total treatment time ranging from 4 to 5 minutes continuously.
Result & Outcome :
Patient X had received total 11 sessions of phototherapy in 6 weeks during 27th September to 4th November 2022. 6 sessions of Bioptron light therapy was firstly started in view of covering more wound bed area. Then, 5 sessions of LLLT were carried out in specific to undermining wound area which cannot be covered by Bioptron easily. The initial wound bed size of Patient X was 7.5 x 8cm with 8cm deepest undermining at 9-11 O’clock. The Pressure Ulcer Scale for Healing (PUSH) Tool 3.0 was scored at 15 out of 17. 20% of slough and 80% of granulation tissue with moderate exudate amount were observed over the wound bed. After 11 sessions of phototherapy, there were improvements over PUSH scores and the wound condition. The wound bed size was 7cmx 6cm with 1cm undermining while the PUSH score improved from 15 to 12. 100% of granulation tissue with significant reduction of exudate to minimal amount was observed over the wound bed. The NPWT was also stopped since 4th November as the exudate amount was reduced. The wound healing was analysed clinically and through the photographs taken. No side effects of phototherapy were detected.The patient was discharged on 17th December with stable wound condition. In the present case, we observed phototherapy provides positive contribution to standard treatments for complicated wound healing, especially the undermining area. There are literature studies that reported the benefits of phototherapy on wound healing too .To conclude, possible benefits on accelerating wound healing in patient with prolonged unhealed pressure injury using phototherapy and hence facilitation of discharge were demonstrated in this case study.
