Phototherapy in DM Amputation Ulcers.
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|ClinicalTrials.gov Identifier: NCT02883751|
Recruitment Status : Withdrawn (The PI is no longer working at UniNove)
First Posted : August 30, 2016
Last Update Posted : March 25, 2020
|Condition or disease||Intervention/treatment||Phase|
|Diabetes Mellitus Amputation Stumps Diabetic Foot||Radiation: LED Procedure: Control group||Not Applicable|
Justification Various studies have demonstrated that phototherapy (laser or LED) is effective at enhancing skin wounds. The biological effects of both forms are similar and related to an increase in fibroblasts, the stimulation of angiogenesis, an increase in collagen synthesis, the formulation of granulation tissue and a reduction in inflammatory cells. Moreover, both forms of phototherapy increase the healed area in a shorter period of time, with LED demonstrating a late-onset effect on the healing process. In patients with partial foot amputation, this time is crucial for the fitting of the prosthetic and, consequently, the beginning of physical therapy and early locomotion. Diminishing the treatment time, with the patient observing a gradual progression in the healing process and experiencing a consequent increase in quality of life, could be a transforming factor to avoid the recurrence of ulcers and avoid further amputations.
Alternative hypothesis: LED therapy is effective at potentiating the complete closure of ulcers in a shorter time following minor amputations in individuals with Diabetes mellitus.
Hull hypothesis: LED therapy is not effective at potentiating the complete closure of ulcers in a shorter time following minor amputations in individuals with Diabetes mellitus.
Methods A single-center, randomized, controlled, double-blind clinical trial with two parallel groups will be conducted in accordance with the criteria contained in the Consolidated Standards of Reporting Trials (CONSORT statement).
The sample will be composed of patients diagnosed with Diabetes mellitus in medical follow up at the vascular outpatient clinic of the Mandaqui Hospital Complex of São Paulo. Twenty patients will be analyzed in each group, as this is the estimate of surgical treatment for each vascular surgeon in a one-year period at the Mandaqui Hospital Complex.
Randomization and formation of groups Patient allocation will be performed by a researcher with no contact with the patients or main researchers. Randomization will be conducted in blocks of four for the balanced distribution of the experimental groups. For such, a lottery of 40 numbers will be conducted using a free program available at http://www.randomization.com, version from March 29, 2013.
Opaque envelopes will be identified with sequential numbers. A piece of paper containing information on the corresponding group determined through the randomization process (control or LED) will be placed into each envelope. The envelopes will remain sealed in numeric order in a secure location until the time of the treatments of the post-amputation ulcers. The researcher in charge of the randomization process and preparation of the envelopes will not be involved in any other aspect of the study.
Immediately following surgery, the main researcher, who will be in the surgical ward, will open an envelope without altering the numeric sequence and will perform the procedure indicated (active LED + bandaging or placebo LED + bandaging). The 40 patients will be allocated to the experimental and control groups in an equal fashion.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||0 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Triple (Participant, Investigator, Outcomes Assessor)|
|Official Title:||Effects of Phototherapy on the Healing of Ulcers Following Minor Lower Extermity Amputations in Patients With Diabetes Mellitus - Protocol for a Randomized, Controlled, Double-blind, Clinical Trial|
|Estimated Study Start Date :||January 2017|
|Estimated Primary Completion Date :||October 2018|
|Estimated Study Completion Date :||December 2020|
Active Comparator: Control group
Control group - gold standard: Conventional ulcer treatment with Rayon® and essential fatty acids (Dersani®). Cleaning of the surgical wound will be performed with saline solution. The wound will then be covered with a sterile polyethylene film, over which the LED plate will be positioned for placebo treatment (emission of sound, but with the device switched off). After 10 minutes, the LED plate and polyethylene film will be removed and the surgical wound will be covered with rayon moistened with essential fatty acids (following the standard protocol of the hospital), followed by the application of gauze and finalization with a crepe bandage.
Procedure: Control group
Conventional ulcer treatment with rayon® (Polar Fix, Polar Fix, Mauá, SP, Brazil) and essential fatty acids (Dersani®, Saniplan, Daudt, São Paulo, SP, Brazil) (composition: decanoic acid, caprylic acid, hexanoic acid, lauric acid, linoleic acid, lecithin, retinyl palmitate, tocopheryl acetate and alpha-tocopheryl).
Experimental: LED group
LED group: Cleaning of the surgical wound will be performed with saline solution and the wound will be covered with a sterile polyethylene film, over which the LED plate will be positioned for active treatment with the device switched on. After 10 minutes, the LED plate and polyethylene film will be removed and the surgical wound will be covered with rayon moistened with essential fatty acids (following the standard protocol of the hospital), followed by the application of gauze and finalization with a crepe bandage.
A device with 36, rectangular, red LEDs, registered with the Brazilian National Health Surveillance Agency (ANVISA authorization nº 8.04554.6), λ = (650 ± 20) nm, with an output power of 324 mW and an output area of 2.54 cm2 (Cosmedical, Brazil), will be enveloped with sterile, disposable, plastic wrap (transparent in the red wavelength) to permit contact with the skin for ten minutes during each session. The plastic wrap will be changed after each use. The amount of energy delivered will be 194.4 J.
Other Name: Photobiomodulation with light emmiting diode (LED)
- Wound closure [ Time Frame: 6 months ]The primary outcome will be the complete closure of the ulcer, which is defined as 100% epithelialization of the operated surface with no exudate, draining or need for bandages.
- Time for closure [ Time Frame: up to 6 months ]time (in days) needed for complete ulcer closure.
- Ulcer closure rate [ Time Frame: up to 6 months ]On a weekly basis, the surgical wounds will be photographed with a digital camera (Canon Powershot S5 IS semi-professional, manual mode) on the upper and lower portions of the foot always at the same distance and with a millimeter scale on the left side for reading by the software program. The area of the ulcers will subsequently be measured with the aid of the ImageJ program (free software, NIH, Maryland, USA) and a software program developed by the research group for this purpose (Deana et al., 2013).
- Cost-benefit ratio of ulcer treatment following minor amputations [ Time Frame: up to 6 months ]The cost-benefit analysis will involve the determination of expenditures on materials, equipment, labor and transportation costs calculated as a function of treatment time.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02883751
|Universidade Nove de Julho|
|São Paulo, SP, Brazil, 01504015|
|Principal Investigator:||Cristiane M Franca, PhD||University of Nove de Julho|