Blue Light for the treatment of complicated wounds in breast surgery

Blue Light for the treatment of complicated wounds in breast surgery

SUMMARY

This pilot study included female patients who devel­oped complicated surgical wounds following breast reconstructive procedures and demonstrated limited response to initial conventional treatments.

The surgical procedures included postmastectomy implant reconstruction following oncological or prophylactic surgery and contralateral symmetry procedures after breast cancer (BC) surgery. All patients were treated with Blue Light Photobiomodulation therapy (EmoLED) in addition to conventional wound care.

The number of Blue Light treatment required to achieve healing were examined. Objective scar rating was conducted at least 1 year after surgery using the Vancouver Scar Scale (VSS). Additionally, a dedicated survey was administered to both patients and surgeons to assess the overall discom­fort associated with EmoLED treatment. Responses were quantified using a Likert scale, ranging from 1 (no discomfort) to 4 (highest discomfort).

This case series included 27 female patients with a median age of 54 years (range 37–66). Five patients presented significant comorbidities, specifically diabetes mellitus (3) and rheumatoid arthritis (2). Additionally, 8 patients were active smokers, and 4 had received neoadjuvant chemotherapy. Three patients were carriers of pathogenic mutations: BRCA1 mutation (1) and BRCA2 mutation (2).

Overall, 20 patients underwent mastectomy with associated implant-based reconstruction. Of these, 19 underwent BC treatment, whereas 1 patient had a prophylactic mastectomy due to a BRCA2 gene mutation. Seven patients underwent contralateral balancing reduction mammaplasty as a second-stage reconstructive surgical procedure following primary mastectomy for BC. Four procedures were bilateral, resulting in a total of 31 surgically treated breasts.

Among the 27 analyzed patients (31 treated breasts) skin necrosis was observed in 18 patients, pre-dominantly affecting the medial skin flaps following Wise pattern skin-reducing mastectomy incisions; 14 of the 18 cases occurred in this area. Partial nipple areola complex (NAC) necrosis was reported in 9 patients, including 1 case of subtotal NAC necrosis. Wound dehiscence was observed in 8 patients, most commonly at the inverted T-junction of Wise pattern incisions, accounting for 7 of the 8 cases.

Notably, all  ischemic-necrotic complications occurred in patients who underwent mastectomy with implant-based reconstruction, except for 2 cases observed in patients who under-went a second-stage balancing reduction mammaplasty. In contrast, the latter group was primarily affected by surgical suture dehiscence, which accounted for 5 of the 7 cases.

The average number of blue light treatments (120s) was 5, typically delivered at 1 treatment per week, resulting in an average healing time of 5 weeks (range 2-10). A higher body mass index (P = 0.075), smoking (0.093), Wise-pattern incision (P = 0.007), thin mastectomy skin flaps (P = 0.034), and subpectoral implant placement (P = 0.033) were associated with an increased number of Blue Light treatments required to achieve healing. No cases of implant loss occurred in this series, even among high-risk patients. Objective scar assessment was performed at least 1 year after surgery in 23 patients (85.2% of the cohort), revealing a median VSS of 5. The specific survey evaluating patient discomfort related to Blue Light treatment showed that all respondents (85.2% of the population) reported no discomfort, scoring 1 out of 4 on the Likert-like scale.

In the article three notable clinical cases are reported.

According to the authors, in this pilot study, Blue Light Photobiomodulation with the EmoLED medical device proved safe, painless, and versatile for treating complicated post-breast reconstructive surgery wounds. With an average healing time of 5 weeks, it prevented implant loss, reduced inflammation and wound exudation, and pro-moted granulation tissue development and high-quality scar tissue formation, even in high-risk cases. Based on these findings, Photobiomodulation with Blue Light could also be extended to advanced oncoplastic procedures and aesthetic breast surgery. Moreover, this treatment is feasible and could be useful in other clinical settings, such as prophylactic intraoperative use to prevent ischemic complications in cases of complex mastectomies.