COMBINED PHOTOTHERAPY/LOW INTENSITY LASER THERAPY IN THE MANAGEMENT OF DIABETIC ISCHAEMIC AND NEUROPATHIC ULCERATION: A SINGLE CASE SERIES INVESTIGATION

This project was designed as a preliminary single case series study to investigate the efficacy of combined phototherapy/low intensity laser therapy in the management of neuropathic and ischaemic foot ulceration. After ethical approval was obtained, four patients suffering chronic ulceration were recruited (average wound area = 57.4 ± 4.5 mm2 ) ; all attended the Chiropody clinic, Belfast City Hospital, N Ireland, on a daily basis (5 days per week) for irradiation of wounds for a total of four weeks. After baseline wound surface area readings were obtained, irradiation was carried out in conjunction with routine debridement and dressings; for the former a 31 diode probe (660 nm - 950 nm) was employed with a constant dosage of 4.2 J/cm2 pulsed at 5 kHz. Wound area was recorded using a combination of tracing and planimetry methods. The principal finding for the patients studied was a significant reduction in wound surface area; as a result of treatment, wound area expressed as a percentage of pre-trial values after two and four weeks of treatment were 46.2 ± 15.5% and 24.2 ± 12.0% respectively (mean ± s.e.m). Analysis of these results using a simple Sign test demonstrated such reductions to be statistically significant (p < 0.05); other positive clinical effects were evident. Thus combined therapy at the chosen parameters would seem to be an effective treatment for such patients. Further studies are therefore indicated to establish optimal irradiation parameters under carefully controlled conditions, and to clinically evaluate the efficacy of this modality for wounds of other aetiologies.