Combined low-intensity laser therapy and hyperbaric oxygen therapy on healing of chronic diabetic foot ulcers: a controlled randomized trial

Abstract Purpose: This investigation was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) photobio modulation (PBM) and hyperbaric oxygen therapy (HBOT) on healing of prolonged diabetic foot ulcers. Patients and Methods: One hundred patients with chronic diabetic foot ulcers (DFU); their ages ranged from 40-65 years. The patients were assigned randomly into four groups. Control group received conventional wound care only, LLLT group received GaAlAs diode laser, its power output was1440 mW with following wave lengths: 5 x 850 nm 200 mW, 12 x 670 nm 10mW, 8 x 880 nm 25 mW, 8 x 950nm 15mW and energy density (flounce) was adjusted for 4 J/cm2 with pulse frequency of 10 KHZ, each session lasted 8 minutes for 3 times per week day after day. HBOT group received 100%pure oxygen under 2.5 ATA delivered for 60 minutes per session for 30 sessions with 5 sessions per week for6 successive weeks. Combined group received combination of both LLLT and HBOT. All groups received standard wound care in addition to their program. Measurements for ulcer surface area (USA) by transparent method and ulcer volume (UV) by volumetric method were performed before starting the study, in the second, fourth- and sixth-weeks post treatment. Results: MANOVA test revealed that there was statistically significant reduction in USA and UV in the LLLT, HBOT and Combined groups (P-value= 001 and 0.0001 in all groups respectively). Regarding USA, there were insignificant differences among groups in the second, fourth, and sixth weeks (P-value= 0.01 for all measurements). Regarding ulcer volume, there were substantial variations post- 2, 4, and 6-weeks tests (P-value= 0.01, 0.0001, and 0.0001 respectively). Multiple comparison in-between groups showed insignificant differences in-between the experimental groups. Conclusion: The combination therapy between LLLT does not accelerate the healing rate in chronic DFU more than and LLLT or HBOT alone.