Avaliação do tratamento de úlceras venosas crônicas com fototerapia (LEDs) e sulfadiazina de prata a 1%

Abstract

Venous ulcer is the most common type of ulcer in the lower limbs, consequent to chronic venous insufficiency. There are several forms to treat them from topical therapies such as 1% silver sulfadiazine cream to biostimulators devices as ultrasound, phototherapy and others. The phototherapy laser or LEDs (lightemitting diode) has been studied, mainly as biostimulator method for tissue repair and pain relief. This study aims to analyze the effectiveness of treatment with phototherapy (LEDs) associated with the daily dressing of 1% silver sulfadiazine cream (SDZ) in patients with chronic venous ulcers. This study was randomized, double-blind, in which device was used for phototherapy (Dynatron 880 Infrared Therapy Probe-Dynatron Solaris) containing 2 probes of similar conformation and their specifications were revealed only at the end of the study: probe 1 (1 LED-644nm, 18mW , 1.12 J/cm 2) and probe 2 (1 LED-641nm and 32 LEDs-891nm; 131mW; 1.57 J/cm 2). Twenty patients were selected from Ulcer Outpatient Clinic of Dermatology Service CSE-FMRP-USP, with 32 chronic venous ulcers, which were created 3 groups (G) by different forms of treatment: G1-probe 1 and SDZ; G2-probe 2 and SDZ and G3-only SDZ, followed by 90 days. After ulcers asepsis, the probes were applied on the wound punctually protected with PVC plastic sheet, to 1.5 J/cm 2 for 30seg/5cm 2 , twice a week, and dressing with SDZ later. Fifthly, the ulcers were photographed digitally and their images were evaluated by the software ImageJ  to measure of the total, granulation tissue (red) and sphacel/fibrin (yellow) areas. The wound healing rates (WHR) were calculated by formula [WHR = Ao-Af) / Ai)], meaning Ao (original area) and Af (final area). The averages of the G2 WHRs were 0.3 and 0.5 in the 30 th and 90 th days, with a significant reduction of the ulcerated areas (p <0.01) when compared to the G3 with averages-0.08 and-0.03 respectively. In the G1, only at the 90 th day, the mean of WHR (0.42) was different from the G3 (-0.03), and p <0.01. Considering the frequency of small ulcers with WHR ≥ 0,4, the G2 has reached this index by 75% of the ulcers in 30 th and 90 th days, while the G1 achieved in 33% of ulcers only in the 60 th day.In the spectrophotometric analysis in the end of the study, it was observed that the 641nm LEDs didn't issued effective light in probe 2, which was mainly constituted of 891nm LEDs. The results showed that the 891nm LED phototherapy accelerated the healing process of chronic venous ulcers in relation to the 644nm LED, and both in relation to the silver sulfadiazine cream to 1%, corroborating evidence from several studies in vivo and in vitro on using of phototherapy (lasers and LEDs) of 600 to 1000nm in tissue repair. Thus, the phototherapy by LEDs showed itself as a good physical method, biostimulator, noninvasive and an adjunct to conventional treatments for venous ulcers, such as silver sulfadiazine to 1%.

Avaliação clínica de úlceras de perna em idosos

“…Em relação à localização da úlcera, estudo de avaliação do tratamento de úlceras venosas crônicas utilizou a mesma classificação em zonas, encontrando dados distintos, em que houve predominância da Zona 2. No entanto, é mister esclarecer, que esta diferença, pode ser explicada, pois neste estudo foram avaliados todos os tipos de úlceras, independente de sua etiologia (venosa, arterial e neuropática) e não somente as úlceras venosas (9) .…”

“…As úlceras venosas estão presentes, geralmente, na região mais distal dos membros inferiores, no maléolo. As úlceras arteriais são comumente encontradas, nos artelhos, calcâneos e proeminências ósseas dos pés e as úlceras neuropáticas localizam-se, em geral, na base dos metatarsos (7)(8)(9)(10) .…”

“…A perda tecidual sofre influência tanto do tipo de úlcera quanto da fase do processo de cicatrização. As úlceras mais superficiais, cujas bordas estão no mesmo nível do leito e avançam para o centro da úlcera, são feridas com boa evolução cicatricial (9) .…”

The use of phototherapy for healing treatments: study of new techniques for tissue neoformation

“…The use of new coatings, among them the use of latex of in animals 5-7 and humans. 3,[8][9][10][11][12][13] Conclusion Therefore, the method of treatment of ulcers through LEDs associated with a latex blade is shown as a positively differentiated approach to those already presented in the literature and currently used in research participants with ulcers in the lower limbs. The RAPHA equipment is intended to treat ulcers presented in external regions of the body which may interact with the light provenient from LEDs, such as diabetic ulcers, which is a chronic wound that occurs in people who, for various reasons, have had a complication of diabetes, pressure ulcers which are very common in bedridden or mobility impaired patients as it is caused by too much pressure in a region of the body that ultimately damages the skin.…”

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“…The use of new coatings, among them the use of latex of in animals [5][6][7] and humans. 3,[8][9][10][11][12][13] Conclusion Therefore, the method of treatment of ulcers through LEDs associated with a latex blade is shown as a positively differentiated approach to those already presented in the literature and currently used in research participants with ulcers in the lower limbs. The RAPHA equipment is intended to treat ulcers presented in external regions of the body which may interact with the light provenient from LEDs, such as diabetic ulcers, which is a chronic wound that occurs in people who, for various reasons, have had a complication of diabetes, pressure ulcers which are very common in bedridden or mobility impaired patients as it is caused by too much pressure in a region of the body that ultimately damages the skin.…”