Description of the effects of photodynamic therapy using laser and LED in subjects with diabetes mellitus presenting plantar ulcers

Abstract

Introduction: Diabetic foot is characterized by infection and / or destruction of soft tissues, with multifactorial pathophysiology. It is one of the most frequent and incapacitating complications of diabetes mellitus, which generates significant expenditure for the Unified Health System. Photodynamic therapy is an efficient treatment in diabetic foot ulcers, triggering bacterial cell death, in addition to stimulating growth factors, which favors the optimization of the healing process. Objectives: The objectives of the present study were to compare the effects of laser therapy on plantar ulcers in patients with diabetic foot and to verify possible changes in pain and wound size after laser therapy. Methods: This was the longitudinal and descriptive study that was performed in the wound care group of Instituto Celulare, Itaipava-Petrópolis/RJ-Brazil. Twenty patients with plantar ulcers due to diabetic foot were analyzed during 10 laser therapy sessions. The participants were divided into two groups: G660nm (n = 10) and G590nm (n = 10). The inclusion criteria were: patients who underwent anamnesis; Physical examination; Morphologic analysis of the wound; Microbiological analysis and bacteriological evaluation. The exclusion criterion adopted was communication difficulty to respond to the anamnesis. The patients were treated with 660nm lasers with 500mw and methylene blue marker (G660nm) or 590nm with 500mw without methylene blue marker (G590nm) with a time of 45min per session at Instituto Celulare. After collection, data regarding wound size, pain intensity and type of bacterial strain were evaluated. In the data treatment, the normality of the distribution was tested. Subsequently, continuous variables were demonstrated through measures of central tendency (mean and median) and dispersion (amplitude and standard deviation). The ANOVA 1-factor test was used to evaluate the effects between the different types of lasers in relation to the size of the wounds and pain intensity. The significance level was 95% (P ≤ 0.05). Results: Our results showed a significant difference (p <0.05) between the effects of lasers (660nm and 590nm) in relation to wound size, in the 7th and 10th sessions. In the analysis of pain, the groups presented a similar behavior until the end of the 8th session, and at the beginning of the 9th session the G660 group did not present pain. There was a significant moderate correlation between the height of the subjects and the size of the wound in both groups (p = 0.046). Conclusion: It was concluded that the use of 660nm and 590nm lasers produces significant results in optimization of the healing process and decrease in pain, mainly the 660nm laser combined with methylene blue.