The influence of low- intensity laser irradiation versus hyperbaric oxygen therapy on transcutaneous oxygen tension in chronic diabetic foot ulcers: a controlled randomized trial

Amir N Wadee; Mohamed Hisham Fouad Aref; Ayman A Nassar; Ibrahim H Aboughaleb; Siham M Fahmy

doi:10.1007/s40200-021-00891-3

The influence of low- intensity laser irradiation versus hyperbaric oxygen therapy on transcutaneous oxygen tension in chronic diabetic foot ulcers: a controlled randomized trial

J Diabetes Metab Disord. 2021 Sep 3;20(2):1489-1497. doi: 10.1007/s40200-021-00891-3. eCollection 2021 Dec.

Authors

Amir N Wadee¹, Mohamed Hisham Fouad Aref², Ayman A Nassar², Ibrahim H Aboughaleb², Siham M Fahmy³

Affiliations

¹ Department of Physical Therapy for Basic Science, Faculty of Physical Therapy, Cairo University and Modern University for Information and Technology, Cairo, Egypt.
² Biomedical Engineering Researcher, Egyptian Armed Forces, Cairo, Egypt.
³ Head of HBOT and Foot Care Center at Kobri El Koba military Hospital, Cairo University and Modern University for Information and Technology, Cairo, Egypt.

Abstract

Background and objective: Evaluation of the stage and severity of the chronic diabetic foot ulcer (CDFU) is vital to increase the healing rate and to select the suitable treatment. We aim to assess the influence of low-intensity laser irradiation (LILI) and hyperbaric oxygenation therapy (HBOT) to accelerate the CDFU healing thru the transcutaneous oxygen tension (TcPO2) measurements.

Materials and methods: Seventy-five diabetic patients (type 2) of both genders, their ages ranged from 40-65 years with CDFUs (duration of ulcer < 6 weeks). All patients were randomly assigned into LILI, HBOT, and the control group. Measurement of TcPO2 using transcutaneous oximetry was performed for all patients once in the baseline and consequently in the second, fourth, and sixth- weeks duration. LILI utilized by a 33-diode cluster contact applicator with output power 1440 mW, energy density (fluency) was adjusted for 4 J/Cm² at 10 kHz, and for 8 min per session, three times per week for a total of consecutive 6 weeks. HBOT was pressurized up to 2.5 ATA and patients delivered 100% oxygen for 60 min per session for 30 sessions. The Control group received conventional wound care only, twice daily, with saline and apply a new bandage after cleaning.

Results: MANOVA revealed a statistically insignificant difference in the control group, while statistically significant improvement in both the LILI and HBOT groups. The intergroup comparisons showed an insignificant statistical difference in the pre-test, while highly statistically significant differences for the three post-measures in favor of HBOT and LILI groups. The percentage of improvement of the HBOT group was higher than LILI. Post-hoc test using the least significant difference (LSD) revealed statistically significant differences of HBOT in favor of the LILI group.

Conclusion: Both LILI and HBOT may be used as adjunctive methods to improve TcPO2 that accelerate healing in CDFUs. HBOT may be favorable in the improvement of TcPO2 than LILI.

Keywords: Diabetic foot ulceration; Diode laser irradiation; Hyperbaric oxygen therapy; Transcutaneous oxygen tension.