Efeitos da laserterapia em pacientes com pé diabético / Effects of laser therapy on patients with diabetic foot

Introdução: As úlceras de pé diabético representam uma importante causa de amputações não-traumáticas. A terapia com laser de baixa intensidade tem demonstrado bons resultados ao acelerar a cicatrização de feridas crônicas, sobretudo em condições de microcirculação reduzida. Portanto, o objetivo do estudo é avaliar os efeitos da laserterapia no tratamento dos pacientes com pé diabético.Metodologia: Tratou-se de uma revisão sistemática de estudos contidos nas bases de dados eletrônicos PubMed, LILACS e SciELO, sem restrição de ano, utilizando os descritores "Diabetes mellitus", "Hiperglicemia", "Lasers", "Pé diabético", "Lesão por pressão" nas línguas inglesa e portuguesa. Foram excluídos os estudos não-randomizados, relatos de caso, observações clínicas e revisões. A Cochrane Collaboration foi utilizada para analisar a qualidade metodológica dos estudos.Resultados: Foram encontrados 24 artigos, sendo excluídos 18 por não se adequarem ao objetivo do estudo. Os estudos trazem um resultado estatisticamente significativo da utilização do LLLT no processo de cicatrização das úlceras diabéticas. Apenas um estudo não teve relevância estatística quando comparado ao grupo controle. Ainda assim, todos os autores apresentam eficácia dessa conduta, mesmo de forma indireta.Conclusão: O uso da laserterapia é uma intervenção que promove efeitos importantes na melhora da cicatrização das feridas em pacientes com úlceras diabéticas. No entanto, não há congruência na literatura de quais são os parâmetros mais adequados para aplicação dessa técnica.

Introduction: Diabetic foot ulcers are a major cause of nontraumatic amputations. Low-level laser therapy (LLLT) has shown good results in accelerating chronic wound healing, especially in conditions of reduced microcirculation. Therefore, the objective this study was evaluate the effects of LLLT on the treatment of patients with diabetic foot.Methodology: We conducted a systematic review in the electronic databases PubMed, LILACS, and SciELO, with no restrictions on date of publication. The following terms were used: "Diabetes Mellitus", "Hyperglycemia", "Lasers", "Diabetic Foot", and "Pressure Ulcer", in English and Portuguese. We excluded nonrandomized studies, case reports, clinical observations, and reviews. The Cochrane Collaboration was used to evaluate the methodological quality of the studies.Results: The search yielded 24 articles, of which 18 were excluded because they did not fit the study objective. Study results on the use of LLLT for diabetic ulcer healing were statistically significant. Only one study had no statistical significance when compared to the control group. Still, all studies showed LLLT to be effective, even if indirectly.Conclusion: The use of LLLT promotes important effects on the improvement of wound healing in patients with diabetic ulcers. However, there is no consensus on the literature regarding the best parameters to apply this technique.

Photobiomodulation by dual-wavelength low-power laser effects on infected pressure ulcers.

The aim of this study was to evaluate the effects of photobiomodulation (PBM) by dual-wavelength low-power lasers on the healing and bacterial bioburden of pressure ulcer (PU) models. Twenty-five male Swiss mice were divided into five equal groups. Ischemia reperfusion cycles were employed to cause PU formation by the external application of magnetic plates. Immediately after wounding, a suspension of Pantoea agglomerans was applied at the base of all the wounds of the infected groups, using a calibrated pipette. PBM (simultaneous emission at 660 and 808 nm, 142.8 J/cm2, in continuous wave emission mode) was applied to the PUs for 14 sessions. The animals were euthanized 14 days after PU induction, and their tissues were analyzed for wound contraction and reepithelialization, epidermis thickness, bacterial survival, and IL-1ß and IL-10 mRNA level evaluations. The PU areas appeared larger in the mice from the infected groups than in those in the laser group 4 days after PU induction and presented incomplete reepithelialization 14 days after PU induction. However, the PBM accelerated the wound healing in the infected + laser group compared with the infected group 11 and 14 days following the PU induction. The infected and irradiated PUs exhibited a thinner neo-epidermis than those in the infected group, and the bacterial survival decreased in the laser group; the relative expression IL-1ß mRNA levels demonstrated an increasing tendency while the relative expression IL-10 mRNA levels demonstrated a decreasing tendency in the infected + laser and laser groups. These results suggest that PBM improves healing by killing or inhibiting bacteria in PUs as well as by accelerating the wound healing, resulting in tissue repair.

Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach.

GENERAL PURPOSE: To provide background and examine evidence for the therapeutic application of light energy treatments for wound healing. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be better able to:1. Explain the basics of lasers, light-emitting diodes, and light-tissue interactions as they apply to photobiomodulation therapy.2. Summarize the results of the authors' literature review of the evidence regarding the therapeutic applications of photobiomodulation treatments for wound healing. ABSTRACT: To provide background and examine evidence for the therapeutic applications of light energy treatments for wound healing.A search was performed in PubMed for peer-reviewed scientific articles published in the last 5 years using the search terms "photobiomodulation therapy" and "low-level laser therapy," and these terms combined with "wound," using a "human species" filter. This search yielded 218 articles on photobiomodulation therapy or low-level laser therapy and wounds. Of these, only articles on in vivo wound care using light treatments were specifically included in this review (n = 11).The wound healing effects of low-dose laser treatments were first described over 50 years ago. Various doses ranging from 0.1 to 10 J/cm and wavelengths ranging from 405 to 1,000 nm appear to provide therapeutic benefits for a broad range of chronic wounds. A range of light energy sources from LEDs to lasers have been used and have specific advantages and limitations. There is a lack of consensus on standardized treatment parameters such as wavelengths, dose, and therapeutic outcomes in the reviewed studies, preventing direct comparison and clinical protocol recommendation. An expert opinion based on ongoing research studies and reported literature is offered.Noninvasive, economical, and multipurpose light devices are an attractive tool for wound management. However, there is an urgent need in the wound care community to develop optimal clinical protocols for use based on well-designed, rigorous clinical research studies.

Laser photobiomodulation in pressure ulcer healing of human diabetic patients: gene expression analysis of inflammatory biochemical markers.

Pressure ulcers (PU) are wounds located mainly on bone surfaces where the tissue under pressure suffers ischemia leading to cellular lesion and necrosis , its causes and the healing process depend on several factors. The aim of this study was evaluating the gene expression of inflammatory/reparative factors: IL6, TNF, VEGF, and TGF, which take part in the tissue healing process under effects of low-level laser therapy (LLLT). In order to perform lesion area analysis, PUs were photographed and computer analyzed. Biochemical analysis was performed sa.mpling ulcer border tissue obtained through biopsy before and after laser therapy and quantitative real-time PCR (qRT-PCR) analysis. The study comprised eight individuals, mean age sixty-two years old, and sacroiliac and calcaneous PU, classified as degree III and IV according to the National Pressure Ulcer Advisory Panel (NPUAP). PUs were irradiated with low-level laser (InGaAIP, 100 mW, 660 nm), energy density 2 J/cm2, once a day, with intervals of 24 h, totaling 12 applications. The lesion area analysis revealed averaged improvement of the granulation tissue size up to 50% from pre- to post-treatment. qRT-PCR analysis revealed that IL6 values were not significantly different before and after treatment, TNF gene expression was reduced, and VEFG and TGF-ß gene expression increased after treatment. After LLLT, wounds presented improvement in gross appearance, with increase in factors VEFG and TGF-ß, and reduction of TNF; despite our promising results, they have to be analyzed carefully as this study did not have a control group.

Application of photodynamic therapy, laser therapy, and a cellulose membrane for calcaneal pressure ulcer treatment in a diabetic patient: A case report.

Diabetes mellitus is a metabolic disorder in which a person has high blood glucose levels due to inadequate insulin production by the pancreas. Wounds in these individuals cannot heal properly over time due to circulatory changes that hinder and stagnate the healing process. We report the case of an 82-year-old female type 2 diabetes mellitus carrier, presenting to clinical-dermatological examination pressure ulcer (PU) in the right calcaneus region. The patient was treated with photodynamic therapy using curcumin and blue light-emitting diodes (LEDs), laser therapy, and the application of a cellulose membrane in order to promote ulcer decontamination by local action, accelerate wound healing, and maintain favorable conditions of asepsis and moisture, respectively. The ulcer healing occurred after 30days of treatment and total epithelialization was observed. From the results obtained in this case report, we conclude that the combination of photodynamic therapy, laser therapy, and coating with a cellulose membrane is a promising treatment for the healing of PU in diabetic patients.

Low-level laser therapy in the treatment of pressure ulcers: systematic review.

The aim of this study was to evaluate the effects of low-level laser therapy (LLT) in pressure ulcers (PU) in humans through a systematic review of randomized studies. The search includes the databases MEDLINE, PEDro, Cochrane CENTRAL, and Lilacs, as well a manual search until May, 2016. This included randomized clinical trials of LLT compared with other interventions, different types of LLT, LLT placebo, or control in the treatment of PU. The outcomes evaluated were the ulcer area, healing rate, and overall healing rate. The risk of bias was evaluated using the tool of the Cochrane Collaboration, and the results were analyzed descriptively. From the 386 articles identified, only four studies were included, with two LLT used with single wavelength (1: 904 nm vs. control and 2: 940 nm vs. 808 nm vs. 658 nm vs. placebo) and two LLT used to probe cluster. One study compared to different single wavelengths showed a significant 71% reduction of the PU and an improved healing rate in which 47% of PU healed completely after 1 month of therapy with the use of LLT with a wavelength of 658 nm compared with other lengths. The other analyzed wavelengths were not significant in the assessed outcomes. Significant results were observed in the use of LLT with a 658 nm wavelength, and no evidence was found for use of wavelengths above that for the treatment of PU. Therefore, we also found no evidence in the laser used to probe the cluster.Registration number: CRD42016036648.

A study of the utility and equivalency of 2 methods of wound measurement: digitized tracing versus digital photography.

OBJECTIVE: To examine agreement between digitized tracing and digital photography methods in measuring wound area and healing rate, and to compare and contrast the 2 methods on feasibility and utility in patient care and research settings. SETTING: Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. PARTICIPANTS: A total of 20 subjects aged 18 years or older with a spinal cord injury and pressure ulcers that were Stage II or higher, and who had received in- or outpatient wound care at the hospital for at least 3 consecutive weeks. METHODS: Wound area was measured at weekly intervals. One assessor calculated wound area from a digitized tracing. A second assessor calculated wound area using a wound photograph. Both assessors used Image-J software. The 2 methods were compared for differences in weekly wound area and weekly healing rate. RESULTS: Methods were different for wound area (P < .0001), whereas there was no difference between methods in weekly healing rate (P = .9429). CONCLUSIONS: The 2 methods are in agreement on the important parameter of healing rate. Both methods are feasible in clinical settings. Wound photography may be more useful than digitized tracings because it simultaneously captures wound appearance.

Ultraviolet-C irradiation in the management of pressure ulcers in people with spinal cord injury: a randomized, placebo-controlled trial.

OBJECTIVE: To compare the effects of ultraviolet-C (UVC) with placebo-UVC on pressure ulcer healing in individuals with spinal cord injury (SCI). DESIGN: Double-blind randomized trial with stratification for ulcer location to buttock or lower extremity. Subjects were followed up for 1 year postintervention. SETTING: Rehabilitation institution. PARTICIPANTS: Adult inpatients and outpatients (N=43) with SCI and stage 2 to 4 pressure ulcers (n=58). INTERVENTIONS: Ulcers and periwound skin were irradiated 3 times per week using UVC or placebo-UVC. The endpoint was wound closure or hospital discharge without closure. MAIN OUTCOME MEASURES: Primary outcome was weekly percent area relative to baseline. Secondary outcomes were mean percent area change between consecutive weeks, surface appearance, weeks to closure, and impact on quality of life and wound status postintervention. RESULTS: Groups were similar at baseline for all demographic characteristics except ulcer duration (P=.02). Groups were similar when healing was compared overall. Subgroup analysis showed that the percent area relative to baseline for stage 2 buttock ulcers was significantly smaller in the group receiving UVC compared with placebo at weeks 3, 5, and 7. During weeks 1 through 8, these ulcers were 26% to 76% of baseline area using UVC versus 111% to 180% for placebo (achieved significant level [ASL], .03-.08; effect size, 0.5-0.8). Groups were similar in the percent area relative to baseline for stage 2 lower extremity ulcers. Group mean percent area change between consecutive weeks for all stage 2 ulcers was 36.6% with the use of UVC and 5.8% for placebo (ASL=.09). There were no group differences in the percent area relative to baseline and the mean percent area change between consecutive weeks for stage 3 to 4 ulcers. Groups were similar for all other secondary outcomes. CONCLUSIONS: UVC is beneficial for stage 2 buttock ulcers. Further studies are warranted using a larger sample size, carefully considered exclusion criteria, and strategies to ensure homogeneity of the groups that are being compared.

Effects of ultraviolet radiation (type B) on wound exudates, appearance and depth description.

Purulent exudate is one of the clinical signs of decubitus ulcers; and it is indicative of infection. The greatest challenge is the decreasing sensitivity of infective micro-organisms to antibiotics. There appears to be paucity of data on the effect of Ultraviolet radiation on wound exudates and appearance. The main purpose of this study was to determine the effect of ultraviolet radiation (Type B) on wound exudates and appearance of decubitus ulcers. Ten (10) bed-ridden subjects with ascertained bilateral sore from unrelieved pressure in their lower extremities consented to participate in the study. The decubitus ulcers were treated with traditional saline-wet-to-moist (WM) wound dressing. The decubitus ulcers on the left lower extremities were the experimental limbs and were exposed to ultraviolet radiation as adjunct while the right lower limbs served as control and received only the saline-wet-to-moist (WM) wound dressing. The frequency of treatment was 3 times per week for 6 weeks. The type of exudates produced, amount of exudates, wound appearance and depth description were scored on a 5-point likert scale. The data was analyzed using descriptive statistics and non-parametric inferential statistics (Kruska-Wallis test). The result of the Kruskal Wallis test showed that there was significant improvement in the type of exudates produced by the decubitus ulcers of the experimental (left) limbs (X{2} = 33.71, p < 0.00) when compared with the control limbs. Similarly, there was significant reduction in the amount of exudates produced by the decubitus ulcers of the experimental limbs (X{2} = 30.58, p < 0.00) when compared with that of the control. Also, there was significant improvement in the appearance of the decubitus ulcers (X{2} = 33.01, p< 0.00) and depth description of the experimental (left) limbs compared to that of the control (right). This study concluded that Ultraviolet radiation (Type B) can significantly improve the appearance of decubitus ulcers. Also, it can significantly reduce the amount of purulent exudates and can hasten skin replacement of decubitus ulcers.

Reciprocity of exposure time and irradiance on energy density during photoradiation on wound healing in a murine pressure ulcer model.

BACKGROUND: Energy density and exposure time reciprocity is assumed and routinely used in low-level light therapy (LLLT) regimens. This study examined dose reciprocity effects on wound healing. METHODS: Pressure ulcers were created on seven groups of C57/BL mice (n = 18). Photoradiation was administered (18 days; 5 J/cm(2)/day @ 670 nm) using a custom LED apparatus and treatment matrix varying both intensity and exposure. Control animals were treated similarly, without photoradiation. Ulcer staging was performed using a standardized scale. Changes in stage, wound area and wound closure rates were measured. Histology was performed. RESULTS: Photostimulatory effects at day 7 occurred with parameters of 125 seconds @ 40 mW x 1/day; 625 seconds @ 8 mWx1/day; 62.5 seconds @ 40 mWx2/day; and 312.5 seconds @ 8 mWx2/day; and at day 18 using 625 seconds @ 8 mW and 312.5 seconds @ 8 mWx2/day. Statistically significant increases in wound closure rates occurred using 625 seconds @ 8 mW; 62.5 seconds @ 40 mWx2/day; and 312.5 seconds @ 8 mWx2/day treatments. Mean ulcer grade scores were similar to controls. CONCLUSIONS: Varying irradiance and exposure time to achieve a specified energy density affects phototherapy outcomes in this model. Variation of exposure time and irradiance may account for conflicting results in the literature. Further studies of these effects are warranted.

Therapeutic ultrasound for pressure ulcers.

BACKGROUND: Pressure ulcers have been recorded as occurring in 5 to 32% of patients admitted to a UK District General Hospital (the precise rate depends on case-mix) and 4 to 7% in the community. They represent a major burden of sickness and reduced quality of life for patients and their carers, and are costly to health service providers. Pressure ulcers are treated by using wound dressings, relieving pressure on the wound, by treating concurrent conditions which may delay healing, and by the use of physical therapies such as electrical stimulation, laser therapy and ultrasound. OBJECTIVES: To assess the effect of therapeutic ultrasound on the healing of pressure ulcers. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register and the Cochrane Central Register of Controlled Trials in May 2006. In addition we hand searched journals, conference proceedings, bibliographies and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing therapeutic ultrasound with sham ultrasound or standard treatment. DATA COLLECTION AND ANALYSIS: Two authors independently checked the result of the search to identify relevant RCTs. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing information by contacting authors. Data extraction was checked by a second author. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar. MAIN RESULTS: Three trials involving 146 people were included. Two RCTs compared ultrasound therapy with sham ultrasound and the third compared a combination of ultrasound and ultraviolet light with laser and with standard treatment. Neither of the two RCTs comparing ultrasound with sham found a significant difference in healing rates. The trials were pooled, in the absence of significant heterogeneity. There was no evidence of benefit associated with the use of ultrasound in the treatment of pressure ulcers. In the three-arm comparison there was no statistically significant difference in ulcers healed. AUTHORS' CONCLUSIONS: There is no evidence of benefit of ultrasound therapy in the treatment of pressure ulcers. However, the possibility of beneficial or harmful effect cannot be ruled out due to the small number of trials, some with methodological limitations and small numbers of participants. Further research is needed.

Electromagnetic therapy for treating pressure ulcers.

BACKGROUND: Pressure ulcers are defined as areas "of localized damage to the skin and underlying tissue caused by pressure, shear, friction and/or the combination of these". In the UK, pressure ulcers occur in 5 to 32% of District General Hospitals people and in 4 to 7% of people in community settings. Electromagnetic therapy, in which electrodes produce an electromagnetic field across the wound, may improve healing of chronic wounds such as pressure ulcers. OBJECTIVES: To assess the effects of electromagnetic therapy on the healing of pressure ulcers. SEARCH STRATEGY: For this first update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy, or other (standard) treatment. DATA COLLECTION AND ANALYSIS: For this first update, two authors independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second author. Meta-analysis was applied to combine the results of trials when the interventions and outcome measures were sufficiently similar. MAIN RESULTS: This update identified no new trials. Two RCTs were identified for inclusion in the original review (total of 60 participants). One was a three-armed study comparing electromagnetic therapy with electromagnetic therapy in combination with standard therapy, and with standard therapy alone, on 17 female and 13 male with grade II and III pressure ulcers. The other study compared electromagnetic therapy with sham therapy in 30 male participants with a spinal cord injury and a grade II or grade III pressure ulcer.Neither study found a statistically significant difference between the healing rates of pressure ulcers in people treated with electromagnetic therapy compared with those in the control group. AUTHORS' CONCLUSIONS: The results provide no evidence of benefit in using electromagnetic therapy to treat pressure ulcers. However, the possibility of a beneficial or harmful effect cannot be ruled out, due to the fact that there were only two included trials both with methodological limitations and small numbers of participants. Further research is recommended.

Photodynamic inactivation of in vitro bacterial cultures from pressure ulcers.

PURPOSE: To evaluate in vitro the antibacterial effect of diode laser light of wavelength 650 nm, in association with the photosensitive substance toluidine blue, on the bacteria in infected skin ulcers. METHODS: Samples were collected by means of swabs containing a medium for transporting infected material from skin ulcers. The material was inoculated into culturing medium containing azide blood agar for the growth of Gram-positive bacteria, and MacConkey agar for Gram-negative bacteria, and incubated for 48 hours. The results obtained from counting the colony-forming units were correlated and subjected to statistical analysis, adopting the significance level of p > or = 0.05. RESULTS: From analysis of variance (ANOVA), the result for the general mean was p = 0.0215. Using the t test with post-hoc test, the result for TBO vs. Control was p = 0.0186, and for TBO + Laser vs. Control it was p = 0.0039. CONCLUSION: There was a significant reduction in colony-forming units when the cultures were subjected to photodynamic therapy.

Photodynamic inactivation of in vitro bacterial cultures from pressure ulcers

PURPOSE: To evaluate in vitro the antibacterial effect of diode laser light of wavelength 650 nm, in association with the photosensitive substance toluidine blue, on the bacteria in infected skin ulcers. METHODS: Samples were collected by means of swabs containing a medium for transporting infected material from skin ulcers. The material was inoculated into culturing medium containing azide blood agar for the growth of Gram-positive bacteria, and MacConkey agar for Gram-negative bacteria, and incubated for 48 hours. The results obtained from counting the colony-forming units were correlated and subjected to statistical analysis, adopting the significance level of p > or = 0.05. RESULTS: From analysis of variance (ANOVA), the result for the general mean was p = 0.0215. Using the t test with post-hoc test, the result for TBO vs. Control was p = 0.0186, and for TBO + Laser vs. Control it was p = 0.0039. CONCLUSION: There was a significant reduction in colony-forming units when the cultures were subjected to photodynamic therapy.

OBJETIVO: Avaliar in vitro o efeito antibacteriano do laser diodo com comprimento de onda de 650nn, associado a substancia fotossensível azul de toluidina sobre as bactérias de ulceras cutâneas infectadas. MÉTODOS: Foram coletadas amostras através de um swab com meio de transporte, de material infectado de úlceras cutâneas. Os materiais foram inoculadas em meios de cultura contendo ágar sangue azida para o crescimento de bactérias gram-positivas e agar Mac Conkey para as gram-negativas, e incubadas por 48 horas. Os resultados obtidos da contagem das unidades formadoras de colônias foram relacionados e submetidos a analise estatística adotando como nível de significância p > ou = 0.05. RESULTADOS: Os resultados da análise de variância ANOVA para a media geral foi p= 0,0215 e para o post hoc test teste t. TBO x Controle p=0,0186, TBO + Laser x Controle p=0,0039. CONCLUSÃO: Houve redução, significativa das unidades formadoras de colônias quando submetidas à terapia fotodinâmica.

Uso de laser de baixa intensidade, AsALGa, 830nm, em pacientes portadores de úlceras de pressão / Use of low level laser therapy, AsALGa, 830nm, in patient bearers of pressure ulcers

As úlceras de pressão são áreas de necrose tissular que se originam basicamente pela isquemia tecidual prolongada, quando o tecido mole é comprimido entre uma proeminência óssea e uma superfície externa por período prolongado. Dentre os tratamentos para as úlceras de pressão está o uso de laser de baixa potência, com comprimentos de onda variando do visível ao infravermelho. O objetivo deste estudo foi verificar o uso do laser AsALGa, 830nm, como atuante no processo de cicatrização de úlceras de pressão graus 3 e 4. O estudo foi realizado no Hospital Universitário do Oeste de Paraná, no qual participaram cinco pacientes com total de sete úlceras de pressão; uma considerada como controle e as outras seis receberam aplicação diária de laser com dose de 4J/cm2, durante 10 dias. Verificou-se uma redução de 30,42 por cento nas áreas das úlceras tratadas, com valores estatisticamente significativos (p=0,0277) e de 12,3 por cento na área da úlcera-controle. Conclui-se que com a aplicação do laser de baixa portência, AsAlGa, 830nm, em dose de 4J/cm2, pontual, houve um aumento na velocidade de cicatrização em relação ao paciente controle.

Temperature-controlled 830-nm low-level laser therapy of experimental pressure ulcers.

OBJECTIVE: This study was performed to evaluate the effectiveness of near-infrared low-level laser therapy (LLLT) treatment of pressure ulcers under temperature-controlled conditions. BACKGROUND DATA: Little information is available regarding the potential thermal effects of near-infrared photo-radiation during LLLT. METHODS: Pressure ulcers were created in C57BL mice by placing the dorsal skin between two round ceramic magnetic plates (12.0 x 5.0 mm, 2.4 g, 1 K Gauss) for three 12-h cycles. Animals were divided into three groups (n = 9) for daily light therapy (830 nm, CW, 5.0 J/cm(2)) on days 3-13 post ulceration in both groups A and B. A special heat-exchange device was applied in Group B to maintain a constant temperature at the skin surface (30 degrees C). Group C served as controls, with irradiation at 5.0 J/cm(2) using an incandescent light source. Temperature of the skin surface, and temperature alterations during treatment were monitored. The wound area was measured and the rate and time to complete healing were noted. RESULTS: The maximum temperature change during therapy was 2.0 +/- 0.64 degrees C in Group A, 0.2 +/- 0.2 degrees C in Group B and 3.54 degrees C +/- 0.72 in Group C. Complete wound closure occurred at 18 +/- 4 days in Groups A and B and 25 +/- 6 days in Group C (p

Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomised clinical trial.

Low-level laser therapy (LLLT) has been suggested as a promising treatment option for open wounds. In view of the absence of randomised studies with sufficiently large sample sizes, we assessed the efficacy of LLLT in the treatment of stage III decubitus ulcers. We performed a prospective, observer-blinded multicentre randomised clinical trial to assess the effect of LLLT as adjuvant to standard decubitus care. A total of 86 patients were enrolled into the study. Treatment was the prevailing consensus decubitus treatment (n=47); one group (n=39) had LLLT in addition, five times a week over a period of 6 weeks. The primary outcome measure was the absolute (mm2) and relative (%) wound size reduction at 6 weeks compared to baseline. Secondary outcome measures were the number of patients developing a stage IV ulcer during the study period, and the median change in Norton scores at 6 weeks compared to baseline. Based on the intention-to-treat principle, using last-observation-carried-forward analyses, Mann-Whitney U tests showed that the differences between the two groups in terms of absolute improvement (p=0.23) and relative improvement (p=0.42) were not significant. Because the wound size areas were non-normally distributed, we also analysed the data after logarithmic transformation of the wound size measurements. No significant difference in log(e) improvement scores between groups could be demonstrated (unpaired t-test: p=0.59). During the treatment period 11% of the patients in the control group and 8% of the patients in the LLLT group developed a stage IV decubitus ulcer (Fisher's exact test: p=0.72). The patients' Norton scores did not change during the treatment period. In this trial we found no evidence that justifies using low-level laser therapy as an adjuvant to the consensus decubitus ulcer treatment.

Electromagnetic therapy for the treatment of pressure sores.

BACKGROUND: Electromagnetic therapy is used with the aim of improving the healing of chronic wounds such as pressure sores and venous leg ulcers OBJECTIVES: To assess the effectiveness of electromagnetic therapy in the treatment of pressure sores SEARCH STRATEGY: The Cochrane Wounds Group search strategy was used (see Scope) to search for randomised controlled trials (RCTs) of electromagnetic therapy for the treatment of pressure sores SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy, or other (standard) treatment DATA COLLECTION AND ANALYSIS: Results of searches were scrutinised by one reviewer (and checked by a second) to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. Data extraction was checked by a second reviewer. MAIN RESULTS: A total of two eligible RCTs were identified for inclusion in this review. The first of these studies (Comorosan 1993) was a three armed study comparing electromagnetic therapy, electromagnetic therapy in combination with standard therapy, and standard therapy alone. The second study (Salzburg 1995) was a comparison between electromagnetic therapy and sham therapy on 30 male patients with a spinal cord injury and a grade two or grade three pressure sore. Neither study found a statistically significant difference between the healing rates of electromagnetic therapy treated and control group patients. REVIEWER'S CONCLUSIONS: The results suggest no evidence of a benefit in using electromagnetic therapy to treat pressure sores. However the possibility of a beneficial or harmful effect cannot be ruled out due to the fact there were only two trials with methodological limitations and small numbers of patients.

Therapeutic ultrasound for pressure sores.

BACKGROUND: Pressure sores have been recorded as occurring in 4-10% of patients admitted to a UK District General Hospital (the precise rate depends on case-mix) and in an unknown proportion of patients in the community. They represent a major burden of sickness and reduced quality of life for patients and their carers, and are costly to health service providers. Pressure sores can be treated by using wound dressings, relieving pressure on the wound, by treating concurrent conditions which may delay healing, and by the use of physical therapies such as electrical stimulation, laser therapy and ultrasound. OBJECTIVES: To assess the effectiveness of the use of therapeutic ultrasound in the treatment of pressure sores. SEARCH STRATEGY: The Cochrane Wounds Groups search strategy was used (see Scope) to search for randomised controlled trials (RCTs) of therapeutic ultrasound for the treatment of pressure sores up to December 1999. SELECTION CRITERIA: Randomised controlled trials comparing therapeutic ultrasound with sham ultrasound or other (standard) treatment. DATA COLLECTION AND ANALYSIS: Results of searches were scrutinised by one reviewer to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing information by contacting authors. Data extraction was checked by a second reviewer. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar. MAIN RESULTS: A total of 3 eligible RCTs were identified. Two RCTs compared ultrasound therapy with sham and the third compared a combination of ultrasound and ultraviolet light with laser and with standard treatment. Neither of the two RCTs comparing ultrasound with sham found a significant difference in healing rates. The trials were pooled, in the absence of significant heterogeneity. There was no evidence of benefit associated with the use of ultrasound in the treatment of pressure sores. In the three-arm comparison there was a significant increase in the weekly healing rates associated with the ultrasound/ultraviolet combination compared with laser but no statistically significant difference between ultrasound/ultraviolet and control. REVIEWER'S CONCLUSIONS: The results suggest no apparent evidence of a benefit of ultrasound therapy in the treatment of pressure sores. However the possibility of a beneficial or a harmful effect cannot be ruled out due to the small number of trials with methodogical limitations and small numbers of participants.