Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Author(s)

Tardivo, Joao Paulo ^[1] ; Serrano, Rodrigo ^[1] ; Zimmermann, Livia Maria ^[1] ; Matos, Leandro Luongo ^[2] ; Baptista, Mauricio S. ^[3] ; Silva Pinhal, Maria Aparecida ^[3] ; Atallah, Alvaro N. ^[4]

Affiliation

^[1] Hosp Anchieta, Fac Med ABC, Sao Bernardo Do Campo - Brazil

^[2] Fac Med ABC, Dept Bioquim, Santo Andre - Brazil

^[3] Univ Sao Paulo, Dept Bioquim, Sao Paulo - Brazil

^[4] Univ Fed Sao Paulo, Dept Med, Sao Paulo - Brazil

• Document type: Journal article
• Source: DIABETIC FOOT & ANKLE; v. 8, n. 1 SEP 19 2017.
• Web of Science Citations: 2

Abstract

Background: Diabetic patients are susceptible to developing foot ulcerswith serious complications such as osteomyelitis and amputations. Treatment approaches are still empirical and the benefit of usual procedures such as surgical debridement has not been properly evaluated. Photodynamic Therapy (PDT) is a non-invasive and highly efficient method for the treatment of the diabetic foot, being able to eradicate the infection and to stimulate healing, decreasing considerably the amputation risk. In the day-to-day practice of our service, we have been faced with the question whether debridement is necessary before PDT. In here, we designed a study to answer that question. Methods: Patients were divided in two groups: In one of the groups (n = 17), debridement was performed before PDT and in the other (n = 40) only PDT treatment was performed. PDT sessions were performed once a week in all patients until healing was achieved, as indicated by visual inspection as well as by radiographic and laboratory exams. At the start of the study, the two groups had no statistical differences concerning their clinical features: average age, gender, insulin use, diabetes mellitus onset time and previous amputations. Results: PDT was effective in the treatment of 100% of the patients showing no relapses after one year of follow up. The group submitted to PDT without previous debridement had a statistically significant (p = 0.036, Mann-Whitney) shorter cure time (29 days, similar to 27%). Conclusion: Our data indicates that debridement is not necessary in the treatment of diabetic foot in patients that have enough peripheral arterial perfusion. In addition, we reproduced previous studies confirming that PDT is an efficient, safe, simple and affordable treatment method for the diabetic foot. (AU)

• FAPESP's process: 13/07937-8 - Redoxome - Redox Processes in Biomedicine
• Grantee: Ohara Augusto
• Support type: Research Grants - Research, Innovation and Dissemination Centers - RIDC
• FAPESP's process: 12/50680-5 - Photosensitization in life sciences
• Grantee: Mauricio da Silva Baptista
• Support type: Research Projects - Thematic Grants