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Ulceration of the lower extremities is one of the most important medicosocial problems (Skobelkin et al 1990). In this article, two case studies show that it is the length of time that laser therapy is used that can have a significant impact on ulcer size.
key words
* Leg ulcers
* Wounds
These key words are based on the subject headings from the British Nursing Index.
This article has been subject to double-blind review.
Venous disease, as a cause of ulceration, accounts for up to 90 per cent of all chronic wounds of the lower extremity (Baker et al 1991). The prevalence of venous ulceration has been well researched and documented. Cornwall et al (1986) found an incidence of 1.8/1000. Their management places a considerable financial strain upon the National Health Service. Costing of the management of venous ulceration is speculative, but it is estimated that the annual expenditure is L200 million in the UK alone (Freak et al 1995). Furthermore, ulceration of the lower limb is a common cause of morbidity in older people (Goodfield 1997).
While treatment decisions should be made on the grounds of evidence-based practice, where this is lacking the management of venous ulceration has often been pragmatic. The plethora of treatments currently available is not only evidence of this, but also evidence of the lack of the unsurpassed efficacy of any one treatment above the others.
The range of dressings available is vast enzyme cleaners, foams, hydrocolloids, semipermeables, alginates - and tends to be the mainstay of treatment, alongside compression hosiery and bandaging techniques; the latter being well and quantitatively established (Burton 1993). Recent novel treatments include fibrinolytic therapy (Zeegelaar et al 1997), as well as electrotherapeutic and other modalities, such as hyperbaric oxygen, ultrasound and UV light. More aggressive treatments include the application of skin grafting techniques (Kirsner et al 1997). Despite the apparent popularity of many of these treatments, their use has failed to improve clinical results significantly (Sugrue et al 1990).
Low intensity laser therapy
In an attempt to discover an effective treatment for the acceleration of wound healing, low intensity laser therapy (LILT) has emerged. Despite the recent popularity and enthusiastic advocacy of this treatment (Baxter et al 1991), there has been a...