Case Report


Ischemic diabetic foot ulcer when treated in association with photobiomodulation: Case report

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1 Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, Brazil

2 Conjunto Hospitalar do Mandaqui, 4301 Voluntários da Pátria Street, Santana, São Paulo, Brazil

Address correspondence to:

Daniela Fátima Teixeira Silva

Nove de Julho University/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo 01504-001,

Brazil

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Article ID: 101098Z01SP2020

doi: 10.5348/101098Z01SP2020CR

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How to cite this article

Perez ST, Ventura MR, Brigídio EA, Marcos RL, Pavani C, Silva DFT. Ischemic diabetic foot ulcer when treated in association with photobiomodulation: Case report. Int J Case Rep Images 2020;11:101098Z01SP2020.

ABSTRACT


Introduction: Because ischemic diabetic foot has arterial lesions with micro and macroangiopathies, it is challenging successfully treat ulcers even now. This becomes especially true if limb revascularization is impossible due to the particularities of systemic pathology and/or local arterial disease.

Case Report: A 61-year-old male patient with type II Diabetes mellitus, arterial hypertension, chronic arterial insufficiency, single limb, with ischemic calcaneal ulcer and posterior tibial artery occlusion that irrigates the angiosome of the lesion, but unfavorable to revascularization. Defined by conventional treatment with platelet antiaggregant, statin and vasodilator associated with laser photobiomodulation (PBM). Red laser, 660 nm, 108 mW, 2.7 W/cm2, was used to irradiate the ulcer point by point, since the area of the laser beam was smaller than the area of the ulcer (laser beam = 0.04 cm2), in contact mode, 108 J/cm2, 4.32 J, and 10 s per point once a week for 33 weeks. Arterial Doppler ultrasound examinations were performed twice, i.e., after three and six months of treatment. Results: Gradual improvement of blood flow in the ulcer bed with postocclusive flow after three months, and after six months, triphasic flow toward the calcaneus.

Conclusion: Photobiomodulation proved to be effective for the formation of collateral circulation in the occluded vascular bed studied here, despite only partial ulcer healing. Randomized controlled trials should be performed to better understand the effects of PBM.

Keywords: Angiography, Angiosome, Doppler, Phototherapy, Wound

SUPPORTING INFORMATION


Acknowledgments

The authors thank the nursing staff and residents of the Vascular Surgery Outpatient Clinic of the Conjunto Hospitalar do Mandaqui.

Author Contributions

Silvana Torres Perez - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published

Mônica Ribeiro Ventura - Acquisition of data, Drafting the article, Final approval of the version to be published

Eduardo Alves Brigídio - Interpretation of data, Drafting the article, Final approval of the version to be published

Rodrigo Labat Marcos - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Christiane Pavani - Final approval of the version to be published

Daniela Fátima Teixeira Silva - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2020 Silvana Torres Perez et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.