Phototherapy with LED Shows Promising Results in Healing Chronic Wounds in Diabetes Mellitus Patients: A Prospective Randomized Double-Blind Study.

OBJECTIVE: The study examined the influence of phototherapy with light-emitting diodes (LEDs) on chronic diabetic wound healing. BACKGROUND: Chronic diabetic wounds are very difficult to treat due to underlying conditions such as angiopathy and neuropathy, resulting in slow healing rates. Conventional treatment options are often insufficient and do not provide satisfactory outcomes. Phototherapy with LED enhances the healing processes through mechanisms of energy exchange between incoming photons and their target, the main one being cytochrome-c oxidase in mitochondria. METHODS: A double-blind, randomized study included 60 patients with a chronic diabetic wound treated at the University Medical Center Ljubljana between October 1, 2012 and December 1, 2014. Patients were randomized into either an active group (LED group) or a control group (Co-group). The active group was treated with LED 2.4 J/cm2 (wavelengths 625, 660, 850 nm) three times a week for 8 weeks. The Co-group was treated with light that simulated LED. Healing was evaluated using the Falanga wound bed score and wound surface area. RESULTS: The average baseline wound surface before treatment was 1315 mm2 in the LED group and 1584 mm2 in the Co-group (p = 0.80). After 8 weeks, the mean surface in the LED group was 56% of the baseline surface and 65% in the Co-group (p > 0.05). Falanga score evaluation showed significantly faster wound bed healing in the LED group compared with the Co-group (p < 0.05). CONCLUSIONS: According to our results, LED significantly improves healing of chronic diabetic wounds and prepares the wound bed for further coverage options.

Aging Is a Sticky Business.

OBJECTIVE: The objective of this work is to put forward a mechanism by which low-level light [red-to near infrared (NIR) laser or light emitting diodes (LED)] is instrumental in the process of accelerating the healing of wounds. BACKGROUND DATA: Interaction modalities of low-level light with oxidatively stressed cells and tissues are the focus of intense research efforts. Several models of the light/cell-interaction mechanism have been proposed. In the most popular model, cytochrome c oxidase is believed to play the role of the principal acceptor for red-to NIR photons. METHODS: Using as an illustrative example the successful LED treatment of an edematous limb ulcer, the results of recent in vitro tests and complementary laboratory experiments are presented and discussed. RESULTS: The most plausible mechanism of biostimulatory effect of red-to NIR light consists of its impact on the nanoscopic interfacial water layers in mitochondria and the extracellular matrix (ECM) where mitochondrial reactive oxygen species (ROS) induce an increase in the viscosity of the water layers bound to the predominantly hydrophilic surfaces in the intramitochondrial space as well as the ECM, where the process progressively propagates with age. The biostimulatory effect of red-to NIR light consists of counteracting the ROS-induced elevation of interfacial water viscosities, thereby instantly restoring the normal mitochondrial function, including the synthesis of adenosine triphosphate (ATP) by the rotary motor (ATP synthase). CONCLUSIONS: An understanding of the mechanism of interaction of red-to NIR light with mitochondria, cells, and tissues safeguards progress in the field of low-level light therapy (LLLT) and puts us in the position to design better therapies.

Photonic technology for the treatments of venous and arterial ulcers: Case report.

In this report, we report a case study on a 50-year-old male patient with different chronic wounds, such as venous ulcer and arterial ulcer in both legs. These wounds have persisted for more than 10 years, despite the different treatments applied, including, different dressings, hyperbaric camera, as well as the used of several medicines of oral and topical application. The case is addressed with the aim to evaluate if treatment that uses combined techniques such as low level laser therapy (LLLT), photodynamic therapy and cellulose membrane is able to improve healing and reduction of time of treatment in those types of chronic wounds. The results show the clinical protocol is effective for the healing of arterial and venous ulcers and can be considered as a promising possibility.

Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.

Significant populations in burn centers are diabetic burn patients. Healing process in these patients is more difficult due to diabetes complications. The gold standard treatment for patients with grade 3 burn ulcer is split-thickness skin grafting (STSG), but in the diabetic patients, the rate of graft failure and amputation is high due to impaired tissue perfusion. The technique of low level laser therapy (LLLT) improves tissue perfusion and fibroblast proliferation, increases collagen synthesis, and accelerates wound healing. The purpose of this case report is introducing a new therapeutic method for accelerating healing with better prognosis in these patients. The protocols and informed consent were reviewed according to the Medical Ethics, Board of Shahid Beheshti Medical Sciences (IR.SBMU.RAM.REC.13940.363). Diabetic type 2 patients with 13 grade 3 burn ulcers, candidate for amputation, were enrolled in the study. We used a 650-nm red laser light, 2 J/Cm for the bed of the ulcer and an 810-nm infrared laser light 6 J/Cm(2) for the margins along with intravenous laser therapy with a 660-nm red light, before and after STSG for treating grade 3 burn ulcers in 13 diabetic ulcers. The results of this study showed complete healing in the last 8 weeks for all patients who were candidates for amputation. In this case series, we present 13 cases of diabetic ulcer with type 3 burn wound, candidate for amputation, who healed completely using LLLT and STSG. This is the first time that these two techniques are combined for treatment of burn ulcer in diabetic patients. Using LLLT with STSG might be a promising treatment for burn victims especially diabetic patients.

Phototherapy promotes healing of chronic diabetic leg ulcers that failed to respond to other therapies.

OBJECTIVE: We tested the hypothesis that combined 660 and 890 nm LED phototherapy will promote healing of diabetic ulcers that failed to respond to other forms of treatment. RESEARCH DESIGN AND METHODS: A double-blind randomized placebo controlled design was used to study 23 diabetic leg ulcers in two groups of 14 patients. Group one ulcers were cleaned, dressed with 1% silver sulfadiazine cream and treated with "placebo" phototherapy (<1.0 J cm(-2)) twice per week, using a Dynatron Solaris 705(R) device. Group two ulcers were treated similarly but received 3 J cm(-2) dose. RESULTS: At each of 15, 30, 45, 60, 75, and 90 days of healing, mean ulcer granulation and healing rates were significantly higher for group two than the "placebo" group (P < 0.02). While "placebo" treated ulcers worsened during the initial 30 days, group two ulcers healed rapidly; achieving 56% more granulation and 79.2% faster healing by day 30, and maintaining similarly higher rates of granulation and healing over the "placebo" group all through. By day 90, 58.3% of group two ulcers had healed fully and 75% had achieved 90-100% healing. In contrast, only one "placebo" treated ulcer healed fully by day 90; no other ulcer attained > or =90% healing. CONCLUSION: Combined 660 and 890 nm light promotes rapid granulation and healing of diabetic ulcers that failed to respond to other forms of treatment.

Cell proliferation induction: healing chronic wounds through low-energy pulsed radiofrequency.

Chronic lower extremity wounds are a major source of morbidity and health care expenditure across the world. In the last decade, numerous advanced modalities have become available that can help expedite wound healing when standard wound care modalities are unsuccessful. In this case report, the authors present their early experience with one such modality that uses pulsed radiofrequency energy to initiate cell proliferation induction in chronic lower extremity wounds of different etiologies that had failed to respond to standard therapy.

Laser therapy for venous leg ulcers.

OBJECTIVES: To assess the effectiveness of low level laser therapy in the treatment of venous leg ulcers. SEARCH STRATEGY: Searches of 19 databases, hand searching of journals and conference proceedings from 1948 onwards, and examination of bibliographies. SELECTION CRITERIA: Randomised controlled trials comparing low level laser therapy with: sham laser; no laser; non-coherent light. There was no restriction on date or language. The main outcome measure used was complete healing of the ulcers. DATA COLLECTION AND ANALYSIS: Data extraction was done by one reviewer and checked by a second. Meta analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar. MAIN RESULTS: There were 4 eligible trials. Two RCTs compared laser therapy with sham, 1 with ultraviolet therapy and 1 with non-coherent, unpolarised red light. Neither of the two RCTs comparing laser with sham found a significant difference in healing rates; there was no significant of laser evident when the trials were pooled. A three-arm study compared: - laser therapy alone - laser therapy plus infrared light - non-coherent, unpolarised red light. Significantly more ulcers completely healed in the group receiving a combination of laser and infrared light compared with non-coherent, unpolarised red light. A fourth trial compared laser and ultraviolet light and found no difference. REVIEWER'S CONCLUSIONS: We have found no evidence of any benefit associated with low level laser therapy on venous leg ulcer healing. One small study suggests that a combination of laser and infrared light may promote the healing of venous ulcers, however more research is needed.

Treating leg ulcers: the latest techniques.

Several advances in the care and treatment of leg ulcers are currently being developed, including laser therapy, ultrasound and the use of hyperbaric oxygen. In this article, the author describes the theory behind each therapy and the current level of research knowledge on the effectiveness and use of the methods.

[Experimental and clinical substantiation of laser therapy of wounds and trophic ulcers]. / Eksperimenta'lno-klinicheskoe obosnovanie lazeroterapii ran i troficheskikh iazv.

The authors have studied the results of 120 experiments on 60 guinea-pigs and 110 rabbits who received the treatment of modelled fenestrated musculocutaneous wounds and trophic ulcers respectively on the replanted extremity and on the back with helium and neon laser until they healed completely. The authors have demonstrated that the laser therapy accelerates the process of reparative regeneration. In 50 intact rabbits who received local irradiation with helium and neon laser there was an increase in the activity of lysosome enzymes and in the protein metabolism values in the blood serum. The use of the helium and neon laser with the specific density of the irradiation rate of 2.5 mWt/cm2 and the exposition during 5 minutes in the treatment of trophic ulcers and persistent wounds in 56 patients as well as in 38 patients with consequences of injuries to the main blood vessels, the nerve trunks, the muscles and the tendons of the extremities before and after the reconstructive operations testifies to its high efficacy.

[Treatment of acute thrombophlebitis of the lower limbs with laser irradiation]. / Lechenie ostrogo tromboflebita nizhnikh konechnostei lazernym izlucheniem.

Low-intensity helium-neon laser (LG-75) radiation produces a marked analgesic, desensitizing, hypocoagulative, and immunostimulating effect, which can be used in the treatment of acute thrombophlebitis of the lower limbs. Laser therapy alters the phase course of the wound process and in this way improves microcirculation and oxygenation of the tissues, shortens the terms of wound healing, and may be used as the method of choice in the treatment of trophic ulcers of the lower limbs.