Sometimes, interminable problems disappear in an instant. After years without any progress, a sudden flash of insight can change everything. But that's a psychological phenomenon. Light-bulb moments solve frustrating riddles, they don't heal chronic wounds.
Then again, our skin is speckled with photoreceptors. It uses sunlight to create Vitamin D, and can detect light bulbs at the very least. Working out what this mean for wound healing is a riddle of its own. Klox Technologies' fluorescence biomodulation technology was born from solving it. A recent study into the effectiveness of FB Wound's unique LumiHeal phototherapy - conducted across 99 chronic patients with a mean wound age of 35.5 months - found that 47.5% of wounds totally closed after an average of 70.3 days.
"These were really tough, really recalcitrant wounds that had a lot of therapy for a number of years, and they just weren't healing," explains Jason Gugliuzza, senior vice-president at Klox Technologies. "Over that time there are issues with patient quality of life and patient morale; then there's nursing time, physician time, hospital time, and a hell of a lot of money spent. The majority of these wounds had at least one prognosis of poor healing, and our results were impressive." The study was called EUREKA.
Along with photoreceptor cells, human tissues contain photoacceptors, molecules with secondary-light-absorbing capabilities. These, it turns out, can be stimulated by certain wavelengths of light to enhance biological processes. By shining an LED on a wound coated in LumiHeal gel, which contains chromophores that convert light into low-energy fluorescence, it's possible to instigate mitochondrial biogenesis, even in elderly patients, stimulating and enhancing all phases of wound healing.
"Our work on mitochondrial biogenesis has been a real breakthrough," says Gugliuzza. "That primary mechanism of action, interacting with mitochondria to create [the energy-storing molecule] ATP, kick-starts healing and facilitates it across the inflammation, proliferation and remodelling stages. It brings about a cellular response in the wound, so it's an active therapy rather than a passive one."
Fluorescence biomodulation works through a mechanism known as the Stokes shift. Chromophores in the LumiHeal gel absorb photons from the LED and emit fluorescence energy at elongated wavelengths tailored for the unique light-absorbing characteristics of different cell and tissue types in the body. Longer wavelengths within the visible spectrum penetrate into the hypodermis, the deepest layer of the skin, while shorter wavelengths are localised nearer the wound surface and the underlying dermis.
The upshot of this is that in the inflammation phase, LumiHeal reduces the presence of IL6 and TNF alpha - the two main inflammatory markers in a chronic wound. Thereafter, the therapy heightens the proliferative phase by increasing blood flow and angiogenesis, which improves the availability of growth factors and brings about a significant increase in collagen production. In the remodelling phase, the collagen stimulated from within the wound, rather than through its contraction, is optimally aligned and extremely high quality - mimicking the collagen found in healthy human tissue, rather than that which produces hypertrophic scars."It's not one product that fixes one problem," stresses Gugliuzza. "It's looking at the holistic issue of wound healing and stimulating all of those three phases at the same time."
Traditional moist wound healing doesn't feel like a therapy so much as a wound-cleaning, dressing-changing, clinic-visiting chore. By contrast, fluorescence biomodulation requires physician and patient alike to don bright orange-tinted glasses. Then, while the gel is illuminated, it fluoresces through the whole colour spectrum.
"We have excellent patient engagement and compliance with this technology," beams Gugliuzza. "By down-regulating the inflammatory markers we immediately lessen any pain, but, more than that, patients actually feel like they're having a therapy, which keeps them very engaged and very invested."
After the last treatment visit in the EUREKA study, 94.9% of doctors said they would recommend the treatment, which is flexible enough to be combined effectively with moist wound dressing, negative-pressure wound therapy, and to improve outcomes after split-thickness skin grafts. "It's a five-minute procedure," says Gugliuzza, "but it's a very different way of managing a wound."