Effect of low level laser therapy on diabetic foot ulcers: a randomized control trial
DOI:
https://doi.org/10.18203/2349-2902.isj20180821Keywords:
Diabetic foot ulcers, Low level laser therapyAbstract
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.
References
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabet. 2012;3(6):110-7.
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabet Res Clinic Pract. 2011;94(3):311-21.
Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet (London, England). 2005;366(9498):1725-35.
DallaPaola L, Faglia E. Treatment of diabetic foot ulcer: an overview strategy for clinical approach. Curr Diabet Rev. 2006;2(4):431-47.
Leone S, Pascale R, Vitale M, Esposito S. Epidemiology of diabetic foot. Le infezioni in medicina: rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive. 2012;20:8-13.
Viswanathan V. Epidemiology of diabetic foot and management of foot problems in India. Int J Lower Extremity Wounds. 2010;9(3):122-6.
Andrews KL, Houdek MT, Kiemele LJ. Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine. Prosthetics and orthotics international. 2015;39(1):29-39.
Wu SC, Driver VR, Wrobel JS, Armstrong DG. Foot ulcers in the diabetic patient, prevention and treatment. Vascular health and risk management. 2007;3(1):65-76.
Won SH, Chung CY, Park MS, Lee T, Sung KH, Lee SY, et al. Risk factors associated with amputation-free survival in patient with diabetic foot ulcers. Yonsei Med J. 2014;55(5):1373-8.
Eldor R, Raz I, Ben Yehuda A, Boulton AJ. New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies. Diabetic medicine: a Journal of the British Diabetic Association. 2004;21(11):1161-73.
Steed DL. The role of growth factors in wound healing. The Surgical clinics of North America. 1997;77(3):575-86.
Amin N, Doupis J. Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities. World J Diabet. 2016;7(7):153-64.
Schindl M, Kerschan K, Schindl A, Schon H, Heinzl H, Schindl L. Induction of complete wound healing in recalcitrant ulcers by low-intensity laser irradiation depends on ulcer cause and size. Photodermatol Photoimmunol Photomed. 1999;15(1):18-21.
Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of low level laser therapy on wound healing in patients with chronic diabetic foot ulcers-a randomised control trial. Indian J Surg. 2012;74(5):359-63.
Denadai AS, Aydos RD, Silva IS, Olmedo L, de Senna Cardoso BM, da Silva BAK, et al. Acute effects of low-level laser therapy (660nm) on oxidative stress levels in diabetic rats with skin wounds. J Exp Therapeut Oncol. 2017;11(2):85-9.
de Medeiros ML, Araujo-Filho I, da Silva EM, de Sousa Queiroz WS, Soares CD, de Carvalho MG, et al. Effect of low-level laser therapy on angiogenesis and matrix metalloproteinase-2 immunoexpression in wound repair. Lasers in medical science. 2017;32(1):35-43.
Meireles GC, Santos JN, Chagas PO, Moura AP, Pinheiro AL. Effectiveness of laser photobiomodulation at 660 or 780 nanometers on the repair of third-degree burns in diabetic rats. Photomedicine and laser surgery. 2008;26(1):47-54.
Hegde VN, Prabhu V, Rao SB, Chandra S, Kumar P, Satyamoorthy K, et al. Effect of laser dose and treatment schedule on excision wound healing in diabetic mice. Photochemistry and photobiology. 2011;87(6):1433-41.
Carvalho AF, Feitosa MC, Coelho NP, Rebelo VC, Castro JG, Sousa PR, et al. Low-level laser therapy and Calendula officinalis in repairing diabetic foot ulcers. Revista da Escola de Enfermagem da U S P. 2016;50(4):628-34.
Feitosa MC, Carvalho AF, Feitosa VC, Coelho IM, Oliveira RA, Arisawa EA. Effects of the Low-Level Laser Therapy (LLLT) in the process of healing diabetic foot ulcers. Acta cirurgica brasileira. 2015;30(12):852-7.
Hopkins JT, McLoda TA, Seegmiller JG, David Baxter G. Low-Level Laser Therapy Facilitates Superficial Wound Healing in Humans: A Triple-Blind, Sham-Controlled Study. Journal of athletic training. 2004;39(3):223-9.
Kaviani A, Djavid GE, Ataie-Fashtami L, Fateh M, Ghodsi M, Salami M, et al. A randomized clinical trial on the effect of low-level laser therapy on chronic diabetic foot wound healing: a preliminary report. Photomedicine and laser surgery. 2011;29(2):109-14.
Kazemi-Khoo N. Successful treatment of diabetic foot ulcers with low-level laser therapy. The Foot. 2006;16(4):184-7.
Mathur RK, Sahu K, Saraf S, Patheja P, Khan F, Gupta PK. Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers. Lasers in medical science. 2017;32(2):275-82.
Organization WH. Global health estimates: Deaths by cause, age, sex and country, 2000-2012. Geneva, WHO. 2014;9.
Saltmarche AE. Low level laser therapy for healing acute and chronic wounds - the extendicare experience. Inte Wound J. 2008;5(2):351-60.
Tubachi P. Antibacterial effect of low level laser therapy in infective diabetic foot ulcers. IOSR Journal of Dental and Medical Sciences. 2015;14(9):110-4.
Gupta AK, Filonenko N, Salansky N, Sauder DN. The use of low energy photon therapy (LEPT) in venous leg ulcers: a double-blind, placebo-controlled study. Dermatologic surgery: official publication for American Society for Dermatologic Surgery. 1998;24(12):1383-6.
