Articles

Photoengineering of Tissue Repair in Human Cases of Recalcitrant Diabetic Ulcers

We used a double-blind completely randomized clinical trial to determine if treatment with a combination of 660nm and 880nm light improves healing of recalcitrant slow or non-healing diabetic leg ulcers. Subjects were recruited from the ulcer clinic of the Department of Dermatology, University of Sao Paulo Medical School, Ribeirao Preto, Sao Paulo State, Brazil. Eight of 10 patients complied fully with the protocol and were treated with Probe One (placebo treatment) or Probe Two (real treatment) until their ulcers healed fully or for a maximum of 12 weeks. Subjects were treated twice a week during which their ulcers were cleaned with physiological saline and dried. Then phototherapy was applied, following which the sores were dressed with sulfadiazine and covered with gauze and bandage. Given the 100 mW/cm² irradiance of the treatment device, each dot size was treated for 30 seconds, yielding a fluence of 3.0J/cm². Larger ulcers, having more square centimeters, required more time as treatment was applied in the contact mode, sequentially from one spot size to adjoining areas, until the entire ulcer area was completely treated. Treatment was delivered in the contact mode; therefore, to avoid cross-contamination, each ulcer was covered with a clear transparent thin film of plastic verified to have 100% light transmission. Healing of each ulcer was evaluated by digital photography, using a Sony ® DSC-P100. The camera was custom fixed to an aluminum base with a 30cm ruler attached perpendicularly to one end of the fixture. The fixture enabled standardized photography, making it easy for pictures to be taken vertically from a regular distance of 30cm every week (Figure 3). Ulcer area and the area around the granulation in each photograph were then measured using Image J® software. Our measurements reveals that absolute (Ar) and the percent absolute (%Ar) reduction of ulcer size were 2.9 ± 1.6 and 54.0 ± 31.7 for treatment with Probe One, and 12.2 ± 3.7 and 89.0 ± 26.8 for treatment with Probe Two Similarly, absolute granulation (Ga) and percent granulation (%Ga) were 2.2 ± 1.2 and 65.0 ± 37.9 for Probe One. The corresponding values for Probe Two were 10.9 ± 3.3 and 91.8 ± 27.7. The mean rate of healing and granulation of ulcers treated with Probe One were 4.4 ± 2.5% and 5.6 ± 3.2%, while that of ulcers treated with Probe Two were about three times higher, being 15.8% ± 4.8% and 15.8 ± 4.8% respectively. These findings indicate that a combination of 660nm and 880nm light promotes healing of diabetic ulcers that failed to respond to respond to other forms of treatment. Further studies with larger sample sizes are on-going.

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