Eficácia da fototerapia associada à sulfadiazina de prata no tratamento de úlceras venosas crônicas / Efficacy of the phototherapy associated with silver sulphadiazine in the treatment of chronic venous ulcers

Introdução: Várias são as propostas terapêuticas para úlceras de perna venosas crônicas (UVCs), como curativos, ultrassom, aparelhos fotobioestimuladores (laser/LED) e outros. Objetivo: Analisar a eficácia da fototerapia (LED 660/890 nm) com curativo diário de sulfadiazina de prata 1 por cento creme (SDZ) para úlceras venosas crônicas. Métodos: Estudo randomizado, duplo-cego, com aparelho fototerápico com 2 sondas: 1 (LED 660 nm/5mW) e 2 (1 LED 660 nm e 32 LED 890 nm/500 mW). Selecionaram-se 20 pacientes (n = 32 úlceras) do Ambulatório de Úlceras CSE–FMRP–USP, constituindo-se grupos: G1-sonda 1+SDZ; G2-sonda 2+SDZ e G3-SDZ, seguidos por 90 dias. Aplicaram-se sobre as úlceras, as sondas pontualmente (3,0 J/cm2, 30 seg/5cm2, 2x/semana) e posterior curativo SDZ. Quinzenalmente, foram fotografadas e avaliadas pelo software Image Jâ, mensurando-se as áreas [total, de esfacelo (E); e de tecido de granulação (G)], calculando-se índices de cicatrização das úlceras [ICU = (Ai-Af)/Ai)] e relação E/G. Resultados: G2 apresentou redução significante no 30º e 90º dia (p 0,4, G2 alcançou este índice em 75 por cento das úlceras no 30º e 90º dias, enquanto 33 por cento do G1, somente no 60º. Conclusão: A fototerapia (LED’s) associada à SDZ acelerou processo de cicatrização das UVCs (G1/G2), comparada ao creme isoladamente (G3), pelos ICUs e pela relação E/G.

Introduction: Many therapeutic forms were used to treat chronic venous ulcers such as dressing, ultrasound, photobiostimulator (laser/LED) and other. Objective: To analyze effectiveness of photo­therapy (LED 660/890 nm) with 1 percent silver sulfadiazine cream (SDZ) in chronic venous ulcers. Method: Randomized and double-blind study using the phototherapy device with 2 probes: 1 (LED 660 nm/5mW) and 2 (1 LED 660 nm and 32 LED 890 nm, 500 mW). Twenty patients were selected (n = 32 ulcers) from Ulcer Outpatient Clinic of the School Health Center –FMRP–USP, divided into groups: G1-probe1+SDZ, G2-probe2+SDZ and G3-SDZ, during 90 days. The probes were applied on ulcers, punctually (3 J/cm2, 30 sec/5cm2, twice/week) and posterior daily SDZ’s dressing. Fortnightly, the ulcers were photographed and evaluated by Image J® software, measuring the areas [total, sphacellus (S) and granulation tissue(G)], calculating wound healing rate [WHR = (iA-fA)/iA)] and S/G relation. Results: G2 presented significant reduction in the 30th and 90th days (p 0.4, G2 achieved this rate in 75 percent of the ulcers in the 30th and 90th days, while 33 percent of the G1 only in the 60th days. Conclusion: The phototherapy (LED) associated with SDZ accelerated wound healing of the venous ulcers (G1/G2) compared the cream (G3) by WHRs and S/G relation.

Phototherapy improves healing of chronic venous ulcers.

OBJECTIVE: We tested the hypothesis that LED phototherapy with combined 660-nm and 890-nm light will promote healing of venous ulcers that failed to respond to other forms of treatment. BACKGROUND DATA: A variety of dressings, growth factors, and adjunct therapies are used to treat venous ulcers, but none seems to yield satisfactory results. MATERIALS AND METHODS: We used a randomized placebo-controlled double-blind study to compare a total of 20 patients divided with 32 chronic ulcers into three groups. In group 1 the ulcers were cleaned, dressed with 1% silver sulfadiazine (SDZ) cream, and treated with placebo phototherapy (<.03 J/cm(-3)) using a Dynatron Solaris 705 phototherapy research device. In group 2 the ulcers were treated similarly but received real phototherapy (3 J/cm(-2)) instead of placebo. In group 3 (controls), the ulcers were simply cleaned and dressed with SDZ without phototherapy. The ulcers were evaluated with digital photography and computer image analysis over 90 d or until full healing was attained. RESULTS: Ulcers treated with phototherapy healed significantly faster than controls when compared at day 30 (p +/- 0.01), day 60 (p +/- 0.05), and day 90 (p +/- 0.001), and similarly healed faster than the placebo-treated ulcers at days 30 and 90 (p +/- 0.01), but not at day 60. The beneficial effect of phototherapy was more pronounced when the confounding effect of small-sized ulcers was removed from the analysis. Medium- and large-sized ulcers healed significantly faster with treatment (>or=40% rate of healing per month) than placebo or control ulcers (p +/- 0.05). CONCLUSION: Phototherapy promotes healing of chronic venous ulcers, particularly large recalcitrant ulcers that do not respond to conventional treatment.