Effect of low level laser therapy on diabetic foot ulcers: a randomized control trial

Background: Nearly 15% of diabetic patients will suffer from DFU in their life span. Conventional treatment is not effective against the non-healing DFUs so in recent days so many adjuvant therapies which have been tried to stimulate healing process are in use. LLLT, is a non-invasive, pain-free method is considered as a possible treatment option for the diabetic foot syndrome. Aim of this study is to study the role of low level laser therapy on diabetic ulcers, i.e. Reduction in size of the ulcer, faster wound healing, control of infection, cost effectiveness and if secondary procedures like split skin grafting can be avoided.Methods: A total of 100 patients with Diabetic foot ulcer fitting the inclusion criteria was included in the study and they were randomly categorized into control and study group. Patients in the study group received treatment with LLLT. Ulcer bed with edge was irradiated locally with red light (660nm), about 4-8J/cm2 for 20 minutes was delivered for 15 days on daily basis. Conventional dressing was preferred for covering after irradiation and controls were treated with conventional therapy alone which includes dressings with betadine or wet with saline, Course of antibiotic treatment and sloughs removed whenever needed. The size, grade and culture status of the ulcer was assessed on Day 1 and day 15. Duration of stay in hospital was noted to assess cost effectiveness.Results: In LLLT group, after completing 15 days treatment complete wound healing was achieved in 66.6% of grade-1 ulcers and 4.4% of grade-2 ulcers and 96.6% of grade-2 ulcers improved to grade-1. In contrary only 3.4% of grade-2 ulcers improved to Grade 1 and a majority of ulcers remained as such. Reduction in Mean area of ulcer at day-15 was statistically significant in LLLT group (13.74±11.88 to 3.97±5.41cm2 and P<0.001) whereas reduction of mean ulcer area among controls was statistically not significant (19.09±15.03cm2 to 18.80±17.70cm2 and P=0.859). Mean total cost of the treatment was less compared to conventional treatment group. (2264.3±140 Vs 3588.4±68 Rs).Conclusions: Laser therapy is painless, cost effective procedure which induces faster granulation, wound contraction and reepithelialisation, thus accelerates complete wound healing hence avoiding secondary procedures like split skin grafting. Control of infection was also better compared to control group.