Re: LASER and Post-Op Cases

[Guest guest]

Hi Tina,It doesn't look like you had any responses, so I thought I would offer up my 2 cents.With extracapsular repairs and FHO's, where you want scar tissue formation, I tend to laser (or recommend lasering) no more than twice a week. The thought being that the laser can indeed reduce inflammation, which produces scar tissue... which in both cases, is what you want to hold the joint together. Now that being said, you could likely get away with doing an extra treatment in there on the medial joint line / distal swelling (for the cruciate) or the incision (for either post-op)... but the laser will tend to have an effect throughout the general area (and one should bear that in mind).The laser will help with collagen formation... within normal tissues / healing tissues... but if you dissipate the 'inflammatory soup' on the lateral aspect of the stifle / around the hip... then nothing is left to create the scar tissue. So, it's a catch 22... a little bit is okay (pain relief and some reduction of intra-articular inflammation or soft tissue swelling), but too much could be bad.I hope this helps...Laurie

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRTCEO,Four Leg Rehab Inc.Canine Rehab Educational ResourcesWWW.FOURLEG.COMCheck it out!!

Hi All,

I have a question about using LASER for post-op cases. I recently had a surgeon request that I avoid lasering over the implant on a lateral suture for CCL repair. The surgeon felt it would interfere with the inflammatory process and delay the scar tissue formation needed for stabilization.

I was under the impression that laser could help with collagen formation and I have always thought laser improves healing directly post-op.

Please correct me if I am wrong - I've felt that when I am able to get patients to come in directly post-op they do very well (because I can also discuss PROM, icing and other pain management modalities). Should I avoid laser? What about the incision - I know laser is good for the incision - but then I'm still going to affect the implant below!

Help!

Thanks,

Tina

PS - (On a different note - but same concept - I had an FHO referred awhile back that was not on an NSAID directly post-op for the same reason - the surgeon did not want to interfere with scar tissue formation. The dog was quite painful, so I spoke with the surgeon and we agreed to start Rimadyl. I love NSAIDs for post-op pain - so any of you surgeons out there, please give me your input on why you might avoid using it directly post-op)

[Guest guest]

Thanks, Laurie.  That is wonderfully helpful.  Most of my cases aren't able to come in more than 1-2 times in a week (in fact if I get them in twice weekly, I'm ecstatic!).  Since I've had positive results with laser for the post-op recovery, I'll likely continue to offer it, keeping in mind everything you mentioned below.

Thanks again - it's nice to have the input from so many wonderful minds!

 

Hi Tina,It doesn't look like you had any responses, so I thought I would offer up my 2 cents.With extracapsular repairs and FHO's, where you want scar tissue formation, I tend to laser (or recommend lasering) no more than twice a week.  The thought being that the laser can indeed reduce inflammation, which produces scar tissue... which in both cases, is what you want to hold the joint together.  Now that being said, you could likely get away with doing an extra treatment in there on the medial joint line / distal swelling (for the cruciate) or the incision (for either post-op)... but the laser will tend to have an effect throughout the general area (and one should bear that in mind).

The laser will help with collagen formation... within normal tissues / healing tissues... but if you dissipate the 'inflammatory soup' on the lateral aspect of the stifle / around the hip... then nothing is left to create the scar tissue.  

So, it's a catch 22... a little bit is okay (pain relief and some reduction of intra-articular inflammation or soft tissue swelling), but too much could be bad.I hope this helps...

Laurie

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRTCEO,

Four Leg Rehab Inc.Canine Rehab Educational Resources

WWW.FOURLEG.COMCheck it out!!

 

Hi All,

I have a question about using LASER for post-op cases. I recently had a surgeon request that I avoid lasering over the implant on a lateral suture for CCL repair. The surgeon felt it would interfere with the inflammatory process and delay the scar tissue formation needed for stabilization.

I was under the impression that laser could help with collagen formation and I have always thought laser improves healing directly post-op.

Please correct me if I am wrong - I've felt that when I am able to get patients to come in directly post-op they do very well (because I can also discuss PROM, icing and other pain management modalities). Should I avoid laser? What about the incision - I know laser is good for the incision - but then I'm still going to affect the implant below!

Help!

Thanks,

Tina

PS - (On a different note - but same concept - I had an FHO referred awhile back that was not on an NSAID directly post-op for the same reason - the surgeon did not want to interfere with scar tissue formation. The dog was quite painful, so I spoke with the surgeon and we agreed to start Rimadyl. I love NSAIDs for post-op pain - so any of you surgeons out there, please give me your input on why you might avoid using it directly post-op)

[Guest guest]

Tina and Laurie,I couldn't disagree more. Your main question /concern is the creation or prevention of 'scar' tissue and then whether or not to laser post-op or not, yes?If all we were after was scar tissue to 'fix' or stabilize an extra cap ACL repair then why limited approach procedures? Why arthroscopy? Why mini-arthrotomies? Why not just hack away at the joint, paying little attention or mind to the tissues we damage on the way in and just knit them together as tightly as possible when we leave? Likewise w an FHO…just cut some more muscle/ligs/tendons and get that bad bone out of there before sewing it all up as tightly as possible on the way out? Likewise why even reduce inflammation ice and medication since inflammation will lead to scar tissue formation as well?FUNCTION is key and our objective is returning these joints to as 'normal' a functional standpoint as possible as soon as possible post-op. That means a quality surgical repair w exceptional surgical technique, limited restriction to ROM, reduced inflammation post-op, pain completely under control , the joint repaired stable enough to permit use as soon as possible after the repair procedure. So if our surgical technique is focused on a quality repair that means minimal tissue disruption for rapid return to usage by the patient why worry about the amount of laser used post-op? Laser therapy has all manner of documented benefits and no effect on normal healthy cells, with it we can reduce pain, reduce pain causing inflammation, improve vascularization and other factors to speed healing and most assuredly return the leg to full ROM and full or near full usage as possible as soon as possible after the surgical disruption. If we worried about delaying or limiting scar formation why laser any incision postop for that matter? Why? Because the excessive poor holding strength scar tissue is limited and healthy well vascularized higher tensile strength suture line is enhanced w the use of therapy laser light post op…same thing we want from ACL and FHO repairsFor ACLs yes it is true that the implant is not the source of stabilization …ultimately but that is long term we are talking 4-6 months or more after the repair not in the days, weeks and months immediately post-op. It would seem that if getting and keeping or returning these joints to full ROM, balanced wt bearing, pain free stability as soon after surgery would be our goal then I would argue that the evidence for laser therapy-unrestricted post-op use is present and that withholding the modality for fear of slowing or delaying scar tissue formation is quit frankly silliness and inappropriate. As silly I'm afraid as choosing a poorly trained surgeon to do the repair.Kind Regards, Weiner, DVMReply-To: " VetRehab " <VetRehab >Date: Wed, 22 Aug 2012 19:43:44 -0400To: " VetRehab " <VetRehab >Subject: Re: LASER and Post-Op Cases

Thanks, Laurie. That is wonderfully helpful. Most of my cases aren't able to come in more than 1-2 times in a week (in fact if I get them in twice weekly, I'm ecstatic!). Since I've had positive results with laser for the post-op recovery, I'll likely continue to offer it, keeping in mind everything you mentioned below.Thanks again - it's nice to have the input from so many wonderful minds!

Hi Tina,It doesn't look like you had any responses, so I thought I would offer up my 2 cents.With extracapsular repairs and FHO's, where you want scar tissue formation, I tend to laser (or recommend lasering) no more than twice a week. The thought being that the laser can indeed reduce inflammation, which produces scar tissue... which in both cases, is what you want to hold the joint together. Now that being said, you could likely get away with doing an extra treatment in there on the medial joint line / distal swelling (for the cruciate) or the incision (for either post-op)... but the laser will tend to have an effect throughout the general area (and one should bear that in mind).The laser will help with collagen formation... within normal tissues / healing tissues... but if you dissipate the 'inflammatory soup' on the lateral aspect of the stifle / around the hip... then nothing is left to create the scar tissue. So, it's a catch 22... a little bit is okay (pain relief and some reduction of intra-articular inflammation or soft tissue swelling), but too much could be bad.I hope this helps...LaurieLaurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRTCEO,Four Leg Rehab Inc.Canine Rehab Educational ResourcesWWW.FOURLEG.COMCheck it out!!

Hi All,

I have a question about using LASER for post-op cases. I recently had a surgeon request that I avoid lasering over the implant on a lateral suture for CCL repair. The surgeon felt it would interfere with the inflammatory process and delay the scar tissue formation needed for stabilization.

I was under the impression that laser could help with collagen formation and I have always thought laser improves healing directly post-op.

Please correct me if I am wrong - I've felt that when I am able to get patients to come in directly post-op they do very well (because I can also discuss PROM, icing and other pain management modalities). Should I avoid laser? What about the incision - I know laser is good for the incision - but then I'm still going to affect the implant below!

Help!

Thanks,

Tina

PS - (On a different note - but same concept - I had an FHO referred awhile back that was not on an NSAID directly post-op for the same reason - the surgeon did not want to interfere with scar tissue formation. The dog was quite painful, so I spoke with the surgeon and we agreed to start Rimadyl. I love NSAIDs for post-op pain - so any of you surgeons out there, please give me your input on why you might avoid using it directly post-op)