Renee Romero RN, BSN, MS, CLT-LANA
Certified MLD Therapist 
Lymphedema Institute of America, Inc 


There is much happening in the world of lymphology, but most is still in the research stage.  That is why it is so exciting to see a new instrument that is FDA approved, to assist in breaking down the fibrosis that can form in a swollen limb.

As a Vodder trained Lymphedema therapist since 1992, I have been excited about adding the LTU-904 laser to the CDPT regime I use. I have been using the laser for about 3 months now and have very positive feedback from my patients.  I have incorporated the laser as a part of the MLD, - first opening the neck and unaffected axilla.  After doing a few minutes of Manual Lymph Drainage, the tissues soften and fibrotic areas can readily be palpated.  Then I have used the Laser in this area as directed by the recommended protocol.  I hold the laser perpendicular to the skin for 60 seconds per treatment spot and then move the laser 2 cm until the total fibrotic area is covered.  Usually, the time involved is about 9 minutes. (The protocol recommends no more than 9 minutes.)   No one has reported feeling hot or cold or any ill effects.  Some have stated they feel like a sensation of vibration in the tissues.  The fibrotic tissues seem to soften quickly depending on how thick the tissues are.

I have placed the Laser directly in the affected axilla as well with resulting softening of the scarring in this region.  The laser seems to work effectively with scars from reconstructive surgery after breast implants, latissimus dorsi or  tram flaps.  In primary Lymphedema, the laser has softened fibrosis in the upper thigh and calf.  As the tissues soften, lymph begins to flow.  I then continue with the MLD, bandaging and other instructions as needed.  

(In the patient in the photo did not have a cellulitis, but hard fibrotic areas that did respond to the laser.  The area softened, but the skin did not change color.)

*Lymphedema should always be diagnosed by a Physician and treated by a professional trained in CDP or complete decongestive therapy.

The following information is about the new LTU-904 low level laser and how it affects the tissues. 



Finally a new FDA approved Laser for Lymphedema which can assist in breaking down fibrosis in the limb! The LTU-904 Laser Therapy Unit is a hand-held battery powered treatment device, is non-thermal and delivers a controlled series of 200ns bursts of pulses of 904nm laser beam, which is in the near infrared spectrum that is invisible to the human eye.  This invisible wavelength penetrates up to 2cm or _" into the tissue.

Low Level Laser Therapy (LLLT) is reported to have beneficial effects on cells and tissues.  LLLT has been trialed for the treatment of fibrous scar tissue (Thelander and Piller, 2000) and has been shown to affect fibroblasts (Boulton and Marshall, 1986). These effects are important both in treating surgical scars associated with post-mastectomy lymphedema (PML) and in treating the brawny edema that often develops in lymphedematous limbs. There is also a suggestion that LLLT encourages lymphogenesis and stimulates lymphatic motoricity (Leivens, 1985; Lievens, 1991). Finally, LLLT appears to affect macrophage cells (Young et al, 1989) and to stimulate the immune system (Tadakuma, 1993). All of these actions indicate that LLLT could be an appropriate treatment for post-mastectomy lymphedema.  (the clinical trial report is available at www.riancorp.com. )

Protocol
The recommended use of the laser is 3 times a week for 3 weeks.  This is considered one treatment block.   Then there should be one month rest and another treatment block can be started.  Positive effects could last for 3 months after two treatment blocks.
Precautions with the laser 
There are no listed contra-indications with the laser.  However the safety and effectiveness of LTU-904 treatment following mastectomy in pregnant women or children under 18 years have not been established.  

The LTU-904 can be used on patients with pacemakers or implanted orthopedic prosthesis.

LTU laser can be used prior to compression bandaging.  The laser is not effective through the compression bandages as the laser must be in contact with the skin.


Bandages Plus, Inc. is a distributor for the LTU-904 laser.  
For more information on the laser, please email:
renee@bandagesplus.com 
Renee Romero RN, CLT-LANA
Certified Lymphedema Therapist