Effect of NASA Light Emitted Diode Irradiation on Chronic Non Healed Post Below Knee Amputation Presented by Haitham Amin Elessawy

Introduction Amputation Wound Wounds associated with amputation of the lower extremity continue to be a challenge. Patients who endure such wounds are often in poor health, with co-existing medical pathologies. Surgical wound management in the lower extremity amputee has moved into a new era where complications such as infection, tissue necrosis and dehiscence targeted as a priority to be resolved earlier Page 1

Introduction trend in postoperative tissue viability problems where skin fragility and multiple pathologies such as diabetes and peripheral vascular disease co-exist. chronic wounds is a growing challenge that requires innovative approaches. The use of NASA light emitting diodes (LED) technology may enhance the natural wound healing process. Page 2

Introduction Page 3 THE OPTICAL PROPERTIES OF THE SKIN Skin penetration depth of optical radiation As you can see the deeper down into the body you want to go... we find infrared and near- infrared light to be of most benefit of wavelength 880 nm to 1000 nm.. Red at 660 nm wavelength is found to be of the most resonant to the human cell and skin surface...

Introduction  light treatment with a light-emitting diode array at 670 nm (LED) is therapeutic in stimulating cellular events involving increases in cytochrome oxidase activity.  (near infrared) wavelength is absorbed in the cellular membrane rather than in cellular organelles, which remain the target when using light in the visible spectrum. This wavelength of irradiation leads to accelerated fibroblast-myofibroblast transformation and mast cell degranulation. In addition, chemotaxis and phagocytic activity of leucocytes and macrophages are enhanced. Page 4

Introduction Page 5 NASA LEDs offers an effective alternative to lasers. These diodes can be configured to produce multiple wavelengths, can be arranged in large, flat arrays (allowing treatment of large wounds), and produce no heat. It is also of importance to note that LED light therapy has been deemed a non significant risk by the FDA. Wounds are slow to heal in a microgravity environment. are well documented in astronauts, and various minor injuries have been reported not to heal until landing on Earth., LED arrays could be used for improved wound healing and in the treatment of problem wounds, as well as speeding deconditioned personnel to full-duty performance.

Significance of the study: Physical therapy approaches that deal with chronic non healed post below knee amputation will decrease the significant psychological, social and functional impact on individuals. On the other hand, finding out a physical therapy modality that has positive effects on the treatment of that condition will enhance the use of physical therapy in that field. Page 6

Thirty patients with delayed wound healing post below knee amputation lasting longer than four weeks will be recruited in the study. They will be selected from Otto Bock Center for amputee. Informed consent for participation in this study will be obtained in writing from all patients. Patients participated in this study will have the following criteria: Inclusive Criteria: Patients with delayed wound healing post below knee amputation. Patient's age ranges from 50 to 70 years old. Both sexes were included in the study. Exclusive Criteria: Patients who had any pathological conditions or associated injuries which may affect the results of the study. Subjects: Page 7

Patients will be randomly divided into two groups: (1) Group A (LED Therapy Group): Fifteen patients receive LED therapy for 24 sessions, three days per week in addition to standard medical treatment which given for the post surgical delayed wound healing. (2) Group B (Standard Medical Therapy Group): Fifteen patients receive standard medical treatment for 24 sessions. They will be instructed to receive this treatment 3 times per week. Page 8

Equipments Page 9 A) Measurement tools: Digital Camera. Double sterilized transparent plastic films. Specialized software program (ImageJ 1.47V software Java- based image processing program developed at the National Institutes of Health, USA).Java image processing National Institutes of Health Specialized software program (Adobe Photoshop CS3,assisted by magnetic lasso tool, USA) B) Therapeutic equipment: LED therapy device: WARP 10 LED (Quantum Devices Inc, 112 Orbison Street, Barneveld, USA 2003).

Warp 10 (LED Light Therapy) by Quantum Page 10

LED Light Safety Page 11

Procedures a) Measuring Procedures: 1- Measurement of Wound Surface Area Using Digital Camera: The digital camera will be placed through a constant distance on a tripod from patient’s wound to capture a colored picture of the wound to detect the size changes of the wound before treatment and at 12, and 24 sessions of treatment. The environmental conditions will be controlled such as patient position, camera distance, and orientation and lighting level. A 20-Cm ruler will be included in each photograph field to allow calibration during subsequent measurement procedures. The captured images will be digitized to computer where surface area can be measured by specialized software program (ImageJ 1.47V software Java- based image processing program developed at the National Institutes of Health, USA).Javaimage processingNational Institutes of Health Page 12

2- Measurement of Wound Surface Area Procedure Using Transparency Film: The patient will be positioned in a comfortable position with exposure of the wound. Double sterilized transparent plastic films were placed directly flat and attached to the skin around the wound area with avoidance of any movement and distortion of the wound. Wound margins were traced by the same investigator to establish reliability of measurements. The traced wound margins were transmitted to be a digitized image by scanning the traced transparent film. The digitized wound surface area then calculated by specialized software program (Adobe Photoshop CS3,assisted by magnetic lasso tool, USA). The mean of surface area has been calculated using both methods to ensure reliability of measurements. Pocedures: Page 13

Photoshop CS3 Page 14

Therapeutic Procedures: a- LED Treatment Protocol: Application of LED therapy will be given at power output of 50 mW and energy density of 4 J/cm2 for 8 minutes per session three times per week for 24 sessions. The device will be held vertically against each wound covered by a transparent film by direct contact with slight pressure to minimize power loss due to beam divergence. b- Standard Medical Treatment Protocol: a) Hypoglycemic medications such as insulin injection to control blood glucose level. b) Systemic antibiotics against organisms according to culture tests. d) Irrigation of the wound by normal. e) Dressings: after irrigation of the ulcer. It must be covered with sterile gauze. Page 15

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