Effect of low level laser therapy on diabetic foot ulcers: a randomized control trial

Abstract

Background: Nearly 15% of diabetic patients will suffer from DFU in their life span. Conventional treatment is not effective against the non-healing DFUs so in recent days so many adjuvant therapies which have been tried to stimulate healing process are in use. LLLT, is a non-invasive, pain-free method is considered as a possible treatment option for the diabetic foot syndrome. Aim of this study is to study the role of low level laser therapy on diabetic ulcers, i.e. Reduction in size of the ulcer, faster wound healing, control of infection, cost effectiveness and if secondary procedures like split skin grafting can be avoided.Methods: A total of 100 patients with Diabetic foot ulcer fitting the inclusion criteria was included in the study and they were randomly categorized into control and study group. Patients in the study group received treatment with LLLT. Ulcer bed with edge was irradiated locally with red light (660nm), about 4-8J/cm2 for 20 minutes was delivered for 15 days on daily basis. Conventional dressing was preferred for covering after irradiation and controls were treated with conventional therapy alone which includes dressings with betadine or wet with saline, Course of antibiotic treatment and sloughs removed whenever needed. The size, grade and culture status of the ulcer was assessed on Day 1 and day 15. Duration of stay in hospital was noted to assess cost effectiveness.Results: In LLLT group, after completing 15 days treatment complete wound healing was achieved in 66.6% of grade-1 ulcers and 4.4% of grade-2 ulcers and 96.6% of grade-2 ulcers improved to grade-1. In contrary only 3.4% of grade-2 ulcers improved to Grade 1 and a majority of ulcers remained as such. Reduction in Mean area of ulcer at day-15 was statistically significant in LLLT group (13.74±11.88 to 3.97±5.41cm2 and P<0.001) whereas reduction of mean ulcer area among controls was statistically not significant (19.09±15.03cm2 to 18.80±17.70cm2 and P=0.859). Mean total cost of the treatment was less compared to conventional treatment group. (2264.3±140 Vs 3588.4±68 Rs).Conclusions: Laser therapy is painless, cost effective procedure which induces faster granulation, wound contraction and reepithelialisation, thus accelerates complete wound healing hence avoiding secondary procedures like split skin grafting. Control of infection was also better compared to control group.

Venous ulcer healing treated with conventional therapy and adjuvant laser: is there a difference?

“…Therefore, laser therapy, specifically Low-Level Laser Therapy (LLLT), has been used as an adjuvant to conventional treatment to aid in wound tissue repair since it reduces the inflammatory process, favors recapillarization and neoformation of tissue layers, besides increasing collagen and elastic fibers in the healed area (13)(14)(15)(16) . In this perspective, some randomized studies show, through the evaluation of clinical indicators, tissue regeneration and reduction in the size of chronic lesions (vascular and diabetic) when using this type of adjuvant therapy to conventional treatment (17)(18)(19) .…”

Effects of low-level laser therapy on the healing of foot ulcers in people with diabetes mellitus

“…Approximately 15% of people with DM will suffer from foot ulcers in their lifetime, where conventional treatments such as daily cleansing and dressing with 0.9% saline solution, essential fatty acids, hydrogel and betadine solution have shown little success in progressing tissue repair, with a higher rate of complications [5][6][7] .…”

“…A cohort of 1055 people with DM in 19 specialized centers in Brazil showed that 24.2% had previous foot ulcer and 13.7% prior amputation, and out of these, 5.3% had more than one amputation 8 . Thus, in recent years, adjuvant therapies have been tested to stimulate the wound healing process in people with DM 5 . Among the new therapies, low-level laser therapy (LLLT) is considered a noninvasive, painless, low-cost and effective method of wound treatment, as it acts on the physiological and biochemical events of the healing process [9][10][11] .…”

Efeitos da laserterapia de baixa intensidade na cicatrização de úlceras nos pés em pessoas com diabetes mellitus

“…Aproximadamente 15% das pessoas com DM sofrerão com úlceras nos pés em sua vida útil, em que os tratamentos convencionais, como limpeza e curativo diário com soro fisiológico 0,9%, ácidos graxos essenciais, hidrogel e solução de betadina demonstraram pouco sucesso no progresso do reparo tecidual, com maior índice de complicações [5][6][7] .…”

“…Uma coorte realizada com 1055 pessoas com DM em 19 centros especializados no Brasil evidenciou que 24,2% apresentavam úlcera prévia nos pés e 13,7% amputação anterior, e, destes, 5,3% possuíam mais de uma amputação 8 . Assim, nos últimos anos, terapias adjuvantes foram testadas para estimular o processo de cura de feridas em pessoas com DM 5 . Entre as novas terapias, a laserterapia de baixa intensidade (LBI) é apontada como um método não invasivo, indolor, de baixo custo e com eficácia no tratamento de feridas, por atuar nos eventos fisiológicos e bioquímicos do processo de cicatrização [9][10][11] .…”