Treatment of Diabetic Wounds With Photodynamic Therapy - Preliminary Results

Diabetic patients have greater susceptibility to developing diabetic foot ulcers (DFU), which associated with peripheral arterial disease and/or infection, causes greater difficulty in the healing process. Photodynamic therapy (PDT) presents itself as a promising alternative for ulcer healing. This study aims to analyze the effectiveness and benefits of PDT in the treatment of diabetic wounds, associating the presence of arteriopathy, the size of the lesion, the presence and type of infection and the need for amputation. After the approval of the ethics committee in research and signing of the TCLE, six patients with eight diabetic wounds were evaluated. The study was carried out in an outpatient clinic of a medium complexity hospital in the interior of Minas Gerais, Brazil, with frequency of two weekly meetings, for a period of 5 months. Cultures were collected at the beginning and end of treatment, arterial doppler of the affected lower limb was performed. The photosensitizer used was methylene blue, with subsequent emission of LED light at a power of 100 mW/cm2, for 10 minutes. The data were analyzed by the Qui2 test, using the Software SPSS 25.0, with a significance level of 5% and are described with mean ± EPM. Age was 65.50 ± 7.58 years, 50% male. All had type 2 diabetes mellitus and the disease time was 9.50 ± 8.22 years. Five reported the presence of comorbidities such as SAH and dyslipidemia, and two presented concomitantly nephropathy and retinopathy. One patient was a smoker and two reported previous smoking. All lesions presented grade I classification by Texas classification (superficial cleft not involving tendon, capsule or bone). Five stage B ulcers (infection only), two stage C ulcers (ischemia only) and A stage D ulcer (infection and ischemia). At US arterial doppler, three patients had total viability of the affected limb and three presented arteriopathy, but only two with collateral. There was no association between arteriopathy and injury reduction (p=0.109). The mean area of injury was 11.15 ± 14.93 cm2. There was a reduction of 46.51 ± 31.10%. There was no association between injury area and percentage of reduction (p = 0.213), but there is a tendency for greater reductions in smaller lesions. Infection was present in 75% of the lesions. There was no association between the presence of infection and reduction of lesions (p=0.446). So far, we can conclude that the presence of arteriopathy without collateral, makes the procedure impossible. There was no association with the presence of infection and reduction of the lesion, and can also be used as a stimulator of the healing process. There was no association with wound size and percentage of reduction. It’s a promising therapy that should be better analyzed.