Effect of Low level therapy of Diabetic foot ulcers

Abstract

Background: Diabetes mellitus has become a major public health interest because of its incidence, which is rising day to day remarkably. 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. In this study, the role of low level laser therapy on diabetic ulcers was evaluated to reduce the size of  ulcer, Faster Wound healing, Control of infection, Cost effectiveness and if secondary procedures like split skin grafting can be avoided.

Materials and Methods: A total of 100 patients with Diabetic foot ulcer fitting the inclusion criteria were included in this study and they were randomly categorized into control and study group. Patients in the study group received treatment with LLLT. Ulcer bed was irradiated locally with red light (660nm). Ulcer size and its depth were used as basis to calculate the duration of exposure to deliver 3–10 J/cm2 for 15 to 20 minutes, for 15 days on daily basis. Edge of the ulcer and ulcer floor were irradiated. 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 off when needed. The size of the ulcer was measured before starting the treatment and on day 15 after starting the treatment. Grade of the ulcer and culture status of the ulcer was also 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 by 66.6% of grade-1 ulcers and 4.4% of grade-2 ulcers and 96.6% of grade-2 ulcers were improved to grade-1.In contrary complete wound healing was not found in grade-1 ulcers of controls and 3.4% of grade-2 ulcers improved to Grade 1 and a majority of ulcers remained as such. In LLLT group only 10 subjects had bacterial growth after completing 15 days treatment and no new growth was found but in controls in a majority of cases (85.5% ) growth remained even after-15 and in 18.75% cases, new growth was reported. Reduction in Mean area of ulcer at day-15 was statistically significant in LLLT group (13.74±11.88 to 3.97± 5.41 Cm2 and P<0.001) whereas this reaction of mean ulcer area among controls was statistically not significant.( 19.09 ± 15.03 cm2 to 18.80 ± 17.70 cm2 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)

Conclusion: 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.