LED phototherapy in tissue repair of chronic wounds in people with diabetes: a systematic review

Baracho, Valéria da Silva; Silva, Natália Cristina da; Peixoto, Marco Fabrício Dias; Sampaio, Kinulpe Honorato; Cordeiro, Cláudia Aparecida Fernandes; Lucas, Thabata Coaglio

doi:10.1590/1983-1447.2023.20220274.en

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Systematic Review • Rev. Gaúcha Enferm. 44 • 2023 • https://doi.org/10.1590/1983-1447.2023.20220274.en copy

LED phototherapy in tissue repair of chronic wounds in people with diabetes: a systematic review

Fototerapia LED en la reparación de tejidos de heridas crónicas en personas con diabetes: una revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify scientific evidence of LED photobiomodulation in the treatment and tissue repair of chronic wounds in people with Diabetes Mellitus, types I and II.

Method:

Systematic review conducted from September/2021 to April/2022 in PubMed, LILACS, SCIELO, COHRANE, EMBASE and Web of Science. Randomized and observational clinical trials using LED in wound healing in diabetics, published between 2015 and 2022 were included. Data were descriptively analyzed with title/abstract screening, full text articles reading and definitive selection after meeting the predefined inclusion and exclusion criteria.

Results:

Fromthe total of 840 references, eight articles were selected, that evaluated the effectiveness of LED phototherapy in wounds of diabetic patients.

Conclusion:

LED light proved to be beneficial in tissue repair, with increased production in collagen and fibroblasts, angiogenesis, reduction of inflammation and, consequently, a decrease in lesion size.

Keywords:
Phototherapy; Wound healing; Diabetes Mellitus; Diabetic foot; Foot ulcer

Participant	People with chronic wounds caused by DM I and II
Intervention	LED Photobiomodulation Intervention followed by conventional treatment
Comparator	Conventional treatment or placebo
Outcome	Reduction of wound area and healing
Study Design	Randomized and observational clinical trial

No.	Author/ Year Country/	Participants	Study Design/ Level of evidence	Intervention group (IG)	Control group (CG)	Frequency	Method for wound assessment	Treatment outcome
01	Nteleki B, Abrahamse H, Houreld NN. (2015) South Africa3333. Nteleki B, Abrahamse H, Houreld NN. Conventional podiatric intervention and phototherapy in the treatment of diabetic ulcers. Semin Vasc Surg. 2015;28(3-4):172-83. doi: http://doi.org/10.1053/j.semvascsurg.2016.02.001 http://doi.org/10.1053/j.semvascsurg.201...	Seven adult patients with 15 lower limbs ulcers diagnosed with type II diabetes	Prospective single-blind experimental pilot study.	Group 2: LED phototherapy and standard treatment. Group 3: LED phototherapy of the ulcer and lymph nodes and standard treatment (cleaning with 0.9% SS, Iruxol mono if slough, cured with Silbecor 1% with bandage and Primapore).	Group 1: Placebo LED phototherapy and standard podiatric treatment (cleansing with 0.9% SS, Iruxol mono if slough, Silbecor 1% together with bandage and Primapore.	Twice a week until healing or a maximum period of 90 days	The ulcers were examined visually and by digital photography. Photographs were taken before and after each treatment session. A tripod was used for standardization.	The combination of standard podiatric treatment and LED phototherapy has the potential to stimulate and increase ulcer healing rates. There was an increase in the healing rate in all three groups. Of the 67% ulcers treated with LED phototherapy, 40% healed within eight weeks and only 10% of placebo-treated ulcers healed.
02	Nunes GAMA, Reis MC, RosaMFF, PeixotoLRT, Rocha AF, Rosa SSRF. (201634. Nunes GAMA, Reis MC, Rosa MFF, Peixoto LRT, Rocha AF, Rosa SSRF. A system for treatment of diabetic foot ulcers using LED irradiation and natural latex. Res Biomed Eng. 2016;32(1):3-13. doi: http://doi.org/10.1590/2446-4740.0744 http://doi.org/10.1590/2446-4740.0744... ) Brazil3434. Nunes GAMA, Reis MC, Rosa MFF, Peixoto LRT, Rocha AF, Rosa SSRF. A system for treatment of diabetic foot ulcers using LED irradiation and natural latex. Res Biomed Eng. 2016;32(1):3-13. doi: http://doi.org/10.1590/2446-4740.0744 http://doi.org/10.1590/2446-4740.0744...	Five patients who had ten chronic ulcers associated with diabetic foot	Randomized clinical trial	Eight ulcers treated with a natural latex insole and an LED phototherapy matrix	Five ulcers treated with a standard dressing. Before applying the silver foam dressing, debridement and cleaning with 0.9% saline solution and gauze	Weekly - minimum of 28 days	The ulcers were photographed with a digital camera. The patient sat on chair, with the camera on a tripod parallel to the wounds, with a focal length of 15 cm.	After four weeks the conventional treatment achieved a healing of 51.8% while the treatment with LED phototherapy achieved 78.4%.
03	Frangez I, Cankar K, Frangez HB, SmrkeDM. (2017) Slovenia/ Eastern Europe3535. Frangez I, Cankar K, Frangez HB, Smrke DM. The effect of LED on blood microcirculation during chronic wound healing in diabetic and non-diabetic patients - a prospective, double-blind randomized study. Lasers Med Sci . 2017;32(4):887-94. doi: http://doi.org/10.1007/s10103-017-2189-7 http://doi.org/10.1007/s10103-017-2189-7...	40 diabetic patients and 39 without diabetes with chronic wounds on the lower limbs	Randomized double-blind clinical trial	20 patients with LED phototherapy - (diabetics) 19 patients with LED-phototherapy (non-diabetics)	20 placebo therapy patients (diabetics, control). 20 placebo therapy patients (non-diabetic, control) The placebo was performed with light that simulated LED, but with no known biological effect.	Three times a week for eight weeks	Blood analysis and microcirculation that were assessed by Laser Doppler flowmetry before the first treatment and at the end. Assessment of the wound bed by the Falanga score.	Assessment of the wound bed showed faster healing in the LED-treated groups compared to the control group. Blood flow measured by Doppler revealed greater microcirculation in the groups treated with LED and no difference in the control groups.
04	Romanelli M, Piaggesi A, Scapagnini G, Dini V, Janowska A, Lacopi E, et al. (2018) Italy3636. Romanelli M, Piaggesi A, Scapagnini G, Dini V, Janowska A, Lacopi E, et al. Evaluation of fluorescence biomodulation in the real-life management of chronic wounds: the EUREKA trial. J Wound Care. 2018;27(11):744-53. doi: http://doi.org/10.12968/jowc.2018.27.11.744 http://doi.org/10.12968/jowc.2018.27.11....	99 patients: 52 leg venous ulcers, 32 diabetic foot ulcers and 15 pressure ulcers	Multicenter, prospective, observational and uncontrolled study	Application of a layer of chromophore gel and light in the area with LED for 5 minutes. In combination with standard chronic wound care (debridement and cleaning with 0.9% SS).	-	Fortnightly	The assessment of the area and the healing time of the wound was performed with an imaging device called the Silhouette Imaging System.	Wound closure was achieved in 47 patients: 26 (50%) with venous ulcers (VU), 16 (50%) with diabetic foot and 5 (33.3%) with pressure ulcer (PU). The mean healing time was 41.3 days for diabetic foot, 82.3 days for VU and 81.2 days for PU. 18 wounds did not respond to treatment: 10 (19.2%) VU, 4 (12.5%) diabetic foot and 4 (26.6%) PU.
05	FrangezI, Nizic-Kos T, Frangez HB.(201837. Frangez I; Nizic-Kos T; Frangez HB. Phototherapy with led shows promising results in healing chronic wounds in Diabetes Mellitus patients: a prospective rando-mized double-blind study. Photomed Laser Surg . 2018;36(7):377-82. doi: http://doi.org/10.1089/pho.2017.4382 http://doi.org/10.1089/pho.2017.4382... ) Slovenia/ Eastern Europe3737. Frangez I; Nizic-Kos T; Frangez HB. Phototherapy with led shows promising results in healing chronic wounds in Diabetes Mellitus patients: a prospective rando-mized double-blind study. Photomed Laser Surg . 2018;36(7):377-82. doi: http://doi.org/10.1089/pho.2017.4382 http://doi.org/10.1089/pho.2017.4382...	30 patients with Diabetes Mellitus and chronic wound	Prospective double-blind and randomized study	Application of LED phototherapy in patients with Diabetes Mellitus and chronic wound. There was no specification on the amount of each group.	30 patients treated with light simulating LED phototherapy	Three times/ week for eight weeks	The wound surface was measured using a photography image. The Pressure Ulcer Scale for healing instrument was used. The wound area was compared with the application of different wavelengths: 625,660 and 850 J/cm^2.	In patients who received LED, there was a reduction (56%) of the wound, and in the control group, it reduced by 65% (p>0.05). The rediction of did not vary with different wavelengths. Between the 4^th and 8^th week, there was a significant improvement (p<0.05) in the granulation tissue, with fibrin and exudate. There was no wound complete healing.
06	Ivanova YV, Klimova EM, Prasol VA, Mushenko EV, Korobov AM, Pogorielov MV, et al. (201838. Ivanova YV, Klimova EM, Prasol VA, Mushenko EV, Korobov AM, Pogorielov MV, et al. Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome. Photobiol Photomed. 2018;24:13-20. doi: http://doi.org/10.26565/2076-0612-2018-24-02 http://doi.org/10.26565/2076-0612-2018-2... ) Ukraine3838. Ivanova YV, Klimova EM, Prasol VA, Mushenko EV, Korobov AM, Pogorielov MV, et al. Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome. Photobiol Photomed. 2018;24:13-20. doi: http://doi.org/10.26565/2076-0612-2018-24-02 http://doi.org/10.26565/2076-0612-2018-2...	48 patients with ischemic and neuroischemic forms of diabetic foot syndrome	Randomized clinical trial	24 patients with ischemic foot necrosis. Used violet, blue, green and red LED phototherapy. Debridement was associated with vacuum therapy, autodermoplasty, antiseptics, ointments, sorbent covers, etc.	24 patients with ischemic ischemic foot necrosis and wounds after debridement and daily dressings (antiseptics, ointments, sorbent covers, etc.). It also associated vacuum therapy and autodermoplasty.	Three to five sessions	Clinical, laboratory, non-invasive, invasive tests of patients ate preoperative to determine the extent of disturbance in blood flow, collateral circulation, and microcirculation.	The treatment achieved complete healing in 91.7% of patients, partial healing (more than 50%) in 8.3% of patients, and prevented amputations. There was complete healing by 31 days after surgery. The combination of dressings, LED and growth factor were effective in accelerating healing time.
07	López-Delis A, Rosa SSRF, Souza PEN, CarneiroMLB, Rosa MFF, MacedoYCL, et al. (2018) Brazil2323. López-Delis A, Rosa SSRF, Souza PEN, Carneiro MLB, Rosa MFF, Macedo YCL, et al. Characterization of the cicatrization process in diabetic foot ulcers based on the production of reactive oxygen species. J Diabetes Res. 2018;2018:4641364. doi: https://doi.org/10.1155/2018/4641364 https://doi.org/10.1155/2018/4641364...	15 patients with lower limb ischemia and neuropathic ulcers.	Controlled and randomized study	Group I: Five participants, application of natural latex adhesive + LED phototherapy. Professional nurse made the dressing. Group III: Five participants, application of natural latex adhesive + LED phototherapy. The patient applied the dressing at home.	Group II: Five participants, standard care (use of silver alginate dressings) assisted by nurses	Fortnightly	Two samples of the wound and venous blood were collected to assess the formation of free radicals. Collect tissue from the wound by scraping to assess the healing process. A spectrophotometer was used for measurements.	The association (latex + LED phototherapy) showed acceleration of wound healing with formation of granulation tissue, when compared to the control group. There was a high concentration of free radicals at the beginning and during the treatment and at the end its reduction, in the experimental group, being associated with the wound healing process. The wounds that nurses dressed healed faster and did not develop infection.
08	Vitoriano NAM, Mont’Alverne DGB, Martins MIS, Silva PS, Martins CA, Teixeira H.D, et al. (201939. Vitoriano NAM, Mont’Alverne DGB, Martins MIS, Silva PS, Martins CA, Teixeira HD, et al. Comparative study on laser and LED influence on tissue repair and improvement of neuropathic symptoms during the treatment of diabetic ulcers. Lasers Med Sci . 2019;34(7):1365-71. doi: https://doi.org/10.1007/s10103-019-02724-5 https://doi.org/10.1007/s10103-019-02724... ) Brazil3939. Vitoriano NAM, Mont’Alverne DGB, Martins MIS, Silva PS, Martins CA, Teixeira HD, et al. Comparative study on laser and LED influence on tissue repair and improvement of neuropathic symptoms during the treatment of diabetic ulcers. Lasers Med Sci . 2019;34(7):1365-71. doi: https://doi.org/10.1007/s10103-019-02724-5 https://doi.org/10.1007/s10103-019-02724...	12 patients with diabetic ulcer	Randomized clinical trial, comparative, with a quantitative approach.	Application of LED phototherapy	Wounds treated with GaAlAs Laser	Twice/week with ten sessions	Photographic records and neuropathy assessment.	At the end of the 10^th session, there was a reduction in the wound area of 79.5% in the LASER group and 55.86% in the LED group (p<0.05). As for the percentage, the Laser group showed a reduction of 81.7% and the LED group of 62.26%. As for the assessment of the neuropathic picture, there was a significant improvement (p<0.05) in both therapies.

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[1] Corresponding author:
Valéria da Silva Baracho E-mail: valeriabaracho1@gmail.com