Estudo clínico cego e randomizado sobre o efeito da fotobiomodulação e da terapia fotodinâmica na cicatrização de lesões crônicas
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Data
2021
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Universidade Brasil
Resumo
Chronic wounds can be defined as those that do not advance in relation
to the orderly tissue repair process and compromise anatomical integrity and tissue
repair time. Neuropathic ulcers are chronic lesions and one of the most stigmatizing
sequelae of diabetic foot and leprosy-associated wounds, their presence is quite
impairing for the individual and can lead to deformation and/or amputation of the
affected limb. For the treatment of these wounds, there are a variety of existing topical
products, including hydrogel. Besides, treatment through the use of
photobiomodulation therapy (PBM) and photodynamic therapy (PDT) has shown
positive results in the repair process. Objective: To evaluate the effects of PBM and
PDT with methylene blue, associated or not with urea, on the healing of chronic
wounds caused by diabetes and leprosy. Methodology: This is a blind randomized
clinical trial. There were 17 volunteers with chronic diabetes wounds that were divided
into 4 groups: Group I hydrogel with alginate (n=3), Group II PBM with diode laser λ=
660 nm, power of 100 mW, with 4J applied every 1 cm (n=6), Group III PDT with
methylene blue at 100 µM associated with red emission diode laser λ = 660 nm, power
of 100 mW with 9 J every 1 cm (n=5), and Group IV methylene blue 100 µM PDT
associated with 2M urea (n=4) and the same irradiation parameters as G III. And 13
volunteers with chronic leprosy lesions divided into 4 groups: Group I hydrogel with
alginate (n=3); Group II PBM with diode laser λ= 660 nm, power of 100 mW, with 4J
applied every 1 cm (n=4) ; Group III PDT with methylene blue at 100 µM associated
with red emission diode laser λ = 660 nm, power of 100 mW with 9 J every 1 cm (n=3)
and Group IV PDT with methylene blue at 100 µM associated with 2M urea and the
same irradiation parameters as G III. For the intervention protocol, the volunteers
underwent 8 sessions, comprising 2 sessions a week, on alternate days. Photographic
records were used for the macroscopic evaluation throughout the sessions and the
measurement of the wound was related to the greatest length versus the greatest
width. For all groups, the Pressure Ulcer Scale for Healing (PUSH), was applied to
assess the healing process. Results: This study found that diabetic individuals
undergoing hydrogel therapy (G I) did not present a reduction in chronic wound size.
As measured by the PUSH score, it was not statistically significant (p value = 0.317).
However, it was observed that there was a significant reduction in the size of the
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chronic lesion measured by the PUSH Score between days 1 and 8 in individuals with
diabetes for groups G II (p<0.001), G III (p=0.004) and G IV (p=0.001). It was found
that in individuals with leprosy undergoing hydrogel therapy, the reduction of chronic
wound, measured by the PUSH score, was not statistically significant (p value = 0.096).
However, it was observed that there was a significant reduction in the size of the
chronic lesion measured by the PUSH score between days 1 and 5 in individuals with
leprosy for G II (p value = 0.021), G III (p value = 0.005 ) and G IV PDT+AM 100 µM
associated with 2M urea (p value = 0.034). Conclusion: The therapies with PBM and
PDT with methylene blue, and PDT with methylene blue associated with urea reduce
the size of the chronic wound in diabetic patients, requiring 3 applications. All light
therapies evaluated in the study reduced the size of chronic wounds in leprosy patients
after five applications.
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Palavras-chave
Diabetes, Hanseníase, Terapia fotodinâmica, Laser de baixa potência, Úlcera neuropática