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Combination Therapy of Infections Caused by Injection of Paint Using Medical Laser

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120 Therapy of infections by medical laser
www.wjps.ir /Vol.6/No.1/January 2017www.wjps.ir /Vol.6/No.1/January 2017
Combination Therapy of Infections Caused by
Injection of Paint Using Medical Laser
Shahrokh Attarian1*, Afsaneh Karami2, Faezeh Ayatolahi3
DEAR EDITOR
Doubtlessly, one of the most important developments in medical
science has been the discovery of antibiotics and their use in the
treatment of infectious diseases caused by the various bacteria.
However, every day we witness the emergence of resistant strains
of bacteria which their resistance power against the antibiotics
are increasing; although scientists discover new antibiotics every
year to supply the consumption market, antimicrobial resistance
is a much faster trend and therefore it slows the healing process of
many infectious diseases.1 In the modern medical technologies, it
is tried to eliminate the germs and remove pus of the lesion, as
well as draining out the infection site using alternative solutions
rather than the use of antibiotics.2
Laser is a new technology which in recent years, it has found
many applications in various scientic elds such as military and
civilian industries as well as various branches of medical science.
The action mechanism of laser energy is to absorb the light
energy by the molecules in the tissue which causes the certain
tissue molecules becoming warm, hot and ultimately destroys
them; whereas laser is a mono-wavelength beam of light, it is
able just to heat up and destroy specic structures.3 Some anti-
inammatory effects of laser were previously mentioned.4-6
On May 25th 2013, a 27-year old woman visited the Emergency
Department of Ayatolah Mousavi Hospital with the history
of schizophrenia, drug use, and hyper-lipidemia. During the
examination, it was found that the patient was injected the
paint into the left forearm and right thigh last week which led
to the edema and erythema at the injury site. Two days after the
injection, purulent discharge was observed at the injury. She was
hospitalized initially at the burn unit of the hospital, and then the
patient was transferred to the infectious diseases unit of Valiasr
Hospital due to the severe infection of soft tissue at the injury.
Body temperature=8/36, HR=86, RR=19, BP=10/6.
Through the examination, erythematous lesions were observed
with the necrotic center of 6-7 cm diameter having purulent
discharge on the forearm to the elbow, and also the erythematous
and edematous lesions containing scattered pustules in an
undulation form were seen on the patient’s right thigh injury.
The drugs, including clindamycin, vancomycin, ciprooxacin
and ryfampy have been prescribed for the treatment, as well as
uvoxamine, inderal, respridone, thiothixene, clonazepam, and
pethidine according to the psychiatrist. Later, the arterial and
venous Doppler ultrasound was performed on the injury site with
1. Plastic Surgery, Zanjan University of
Medical Sciences, Zanjan, Iran;
2. Infectious disease specialists, Zanjan
University of Medical Sciences, Zanjan,
Iran;
3. Laser Ward, Zanja n University of Medical
Sciences, Zanjan, Iran
*Corresponding Author:
Shahrokh Attarian, MD;
Department of Plastic
Surgery
,
Zanjan
Universit y of
Medical
Sciences,
Zanjan, Iran
E-mail:
shahrokhatt@gmai.com
Received: Decemb er 2 ,2015
Revised: August 8, 2016
Accepted: December 1, 2016
Letter to Editor
121
Attarian et al.
www.wjps.ir /Vol.6/No.1/January 2017www.wjps.ir /Vol.6/No.1/January 2017
following results.
The venous blood ow in the auxiliary vein,
brachial vein, and cephalic and bazilic proximal
vein network of left elbow was within the normal
range; the arterial blood ow and spectrum
Doppler in the auxiliary and brachial arteries of
the left upper limb was observed in the normal
range. It was not possible to examine the radial
and ulnar arteries due to the dressing on the left
forearm, however, arterial profusion of all left
hand ngers was observed natural.
bone scan: (i) Bony lesion in the right knee
region due to osteomy elitis, and (ii) there
was infection in the soft tissue of the right
thigh as well left lower arm. WBC=11000
(P=70%, L=18%, EO=4%, Mon=8%), Hb=10/7,
PLT=65000, ESR=102, BUN=5/5, CR=0/6, U/
A=normal, NA=142, K=4/2, BS=108, AST=107,
ALT=27, ALP=335, LDH=338, Iron=52,
TIBC=405, Retic=0/8, and Ferritin=736/4.
Later: WBC=11000, HB=11/6, PLT=281000,
ESR=70, and U/C=E. coli.
The major reason of the positive charge
of lesion is the presence of metal cations and
metalloids, such as iron of the hemoglobin in
red blood cells, or calcium and other metals
which exist in the basal membrane. It should be
noted that the reactions between positively and
negatively charged molecules plays an important
role in antimicrobial defense, healing and tissue
growth. Using laser leads the positive charge to
be increased in the lesion site through inuencing
on metals, releasing the electron from valence
shell (outermost electron-occupied shell in the
atom), and transferring it to the amine circuit,
hydroxyl or methyl and ethyl branches of proteins
which contributes considerably in antimicrobial
defense and healing; however, that effect is more
effective in the wave lengths ranged 1064 nm to
532 nm, - i.e. out of the infra red wave length
range, and in the biophotonic form. Note that, for
the wave lengths of infra red, such as 10640 nm
related to CO2 laser, the effects will be mainly
biothermic and biomechanical with the action
of debridement on the lesion or increasing the
vessels surrounding the edge of lesion in a way
that inuences on the healing process. The above
mentioned characteristics lead the CO2 laser to
become one of the most appropriate solutions
for the supplement treatment accompanied with
antibiotics in some of the infectious diseases.7-9
According to the surgeon at the center, it was
more likely to be occurred necrotisin fasciitis,
and the surgeon recommended the debridement.
After the patient examination, the orthopedist
diagnosed the amputation; while, after the
hematological evaluation, it was recommended
to perform a control test in relation to the anemia
and thrombocytopenia according to the normal
blood lamella. During the patient examination
by the plastic surgeon, there was no fever
symptom observed, while septicity and pus of
the lesion was evident; hence, the plastic surgeon
recommended the CO2 and Ar laser therapy as
the treatment of septicity and pus.
The laser treatment was followed by the
treatment has been performed in three below
stages: (i) Discharging the dye from the lesion;
(ii) Draining the infectious site; and (iii) Filing
the lesion site. The abscess stage was performed
in a therapy session in the operation room under
the sedation. The CO2 surgical laser was used
to discharge the paint and pus from the abscess
and prepare the lesion site for the remaining
treatment stages. The technical specications
and light of utilized laser device are as follows:
Wave Length: 10640 nm, Super Plus, and
Continuous. 15 watt
Neutralization of the toxic metals of paint and
also destroying microbes stage was performed
in two sessions on the out-patient basis within
one week interval utilizing the laser device with
below technical specications: Q Switch
2000 MJ, 6 HTZ, 400
At the fourth week, and after the completion
of treatment, the lesion was dressed and the
treatment was considered successful. For
treatment of complex and complicated lesions,
it is possible to utilize the laser technology
in accordance with the standard protocols,
especially photodynamic therapy as the
supplement for the antibiotic therapies and
healing the resistant cases.
CONFLICT OF INTEREST
The authors declare no conict of interest.
KEYWOR DS
Laser; Therapy; Infections
Please cite this paper as:
Attarian S, Karami A, Ayatolahi F. Combination
Therapy of Infections Caused by Injection of
122 Therapy of infections by medical laser
www.wjps.ir /Vol.6/No.1/January 2017www.wjps.ir /Vol.6/No.1/January 2017
Paint Using Medical Laser. World J Plast Surg
2017;6 (1):120-122.
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