Transcutaneous; Oxygen Saturation; Hyperbaric; Oxygen Therapy; Low Level Laser; Diode Laser

There are many types of chronic leg ulcers, most patients with venous leg ulcers from around 60 to 80 percent [1].

This is one of the main causes of morbidity affecting the social and economic conditions of any country [2]. Transcutaneous oxygen saturation (TcPo2) at ulcer margins is one of the widespread methods of measuring partial oxygen pressure dissolved in liquid after penetration of skin levels [3].

In literature, TcPo2 reflects the underlying micro vascular circulation, used to determine peripheral vascular diseases, wound healing assessments, hyperbaric oxygen therapy indications and improvements [4].

Statement of the problem

The delayed ulceration healing and its effects on rate of recovery and period of hospitalization are serious and functional problem, therefore, the selection of the appropriate treatment modalities is one of big challenges to deal with these patients.

Design of the study

This study conducted at Kobri El Kobe Medical Complex, Hyperbaric Oxygen therapy and Foot Care Rehabilitation Center in the period from March 2019 to June2019.

Patients accepted the experimental study and signed an acceptance approval paper before the beginning of the study

Purpose of the study

This study was designed to evaluate the effect of HBO versus LLLT on transcutaneous oxygen saturation for chronic venous leg ulcers which assessed by one method of evaluative approaches.

Subjects 

Forty patients with long lasting chronic venous ulcers suffering from more than 6 weeks without improvement classified randomly into two groups:

Group A: 20 patients treated with low level diode laser therapy. Group B: 20 patients treated with hyperbaric oxygen therapy.

Inclusive Criteria

• Patient’s ages ranged from 20-65.
• All patients are diabetic controlled.
• Patient’ s cardiac ejection fraction must be ≥ 45 was evaluated pre sessions for one time, and blood pressure must be ≤ 150/90 mm\Hg measured pre each session.
• All patients are free from chronic obstructive pulmonary disease, lung fibrosis, pleural effusion and pneumonia .
• All patients’ ears are clinically evaluated to tolerate pressure therapy

The equipment in the present study was delimited into two main equipments

Therapeutic equipment

1. Hyperbaric oxygen chamber at pressure 1.5 Bar, total time of session is 90 minutes included 60 minutes breathing 100% pure oxygen through the individual mask.
2. Scanner Infrared diode laser (wavelengths 880 and 950 nmEnergy density 5J/ cm2 – time of session depended on ulcer parameters) used to focus perpendicular upon the site of venous ulcer with a distance not less than 60 cm. The sessions repeated once daily for 10 days.

Measurement equipment

Transcutaneous hemoglobin saturation with oxygen: Superficial electrode with an individual membrane inserted adhesive to the ulcer margin. The steps for TcPo2 measuring were recorded at the main chamber monitor (Model Module Box 84 TE-serial number: 0216 - 1021-0211).

The measurements were done pre treatment and after 10 days through the study. Time for each evaluation was pre the treatment procedures.

Transcutaneous oxygen saturation for both groups

The mean value of the differences of ulcer TcPo2 between the pre treatment ulcer Tc Po2 and after 10 days of treatment by low level laser in relation to the pre treatment TcPo2 of Group A was 0.265 ± 0.529.

The mean value of the difference of ulcer TcPo2 between the pre treatment ulcer Tc Po2 and after 10 days of treatment by hyperbaric oxygen in relation to the pre treatment TcPo2 of Group B was1.884±0.506 (Figure 1).

The difference between the mean values of increasing transcutaneous oxygen saturation between both groups are more in Group B than Group A (Table 1).

Figure 1: Difference between the mean values and standard deviations of ulcer TcPo2 between the pre treatment ulcer TcPo2 and after ten sessions of treatment in relation to the pre treatment ulcer TcPo2 of both groups

Positive synergistic effects on t issue hyper oxygenation gained from combining hyperbaric oxygen therapy at 1.4 bar partial pressure and infrared therapy [5].

Hyperbaric oxygen therapy leads to increase partial pressure of arterial oxygen estimated by Henry’s law [6] that explained the important role of HBO in tissue repair of the ischemic ulcers through improving energy metabolism and swelling reduction [7].

Building of new capillary network at the site of chronic ulcers requires adequate amount of oxygen concent ration for the tissues to create a powerful angiogenesis’ stimulus combined with fibroblastic proliferation leading to revascularization [8].

Low level laser therapy had serious effects on wound healing on a morphometric study for rats depending on cytokin e level indicated that LLLT enhanced the initial level of the inflammatory stage as an important healing factor in chronic ulcer healing also depending on count of collagen fiber indicated that LLLT extended its effect to the remolding stage of wound healing [9].

Another experimental study investigated the effects of low level laser therapy with wavelength 660nm, 2Jouls/ulcer site on 45 old rats, and recorded high significant positive effects of LLLT on enhancement inflammatory agents and improvement of collagen production through the stages of ulcer healing [10].

Both HBOT and LLLT had positive effects on improving healing and tissue repair established by many studies either for animals or humans. Because tissue oxygenation concerned an important factor for all stages of wound healing and angiogenesis for ischemic t issues, this study concerned to record the level of transcutaneous oxygen saturation pre and post 10 sessions of treatments with both HBOT and LLLT.

Hyperbaric oxygen therapy get the higher mean value recorded 1.884 while the mean value of low level laser therapy recorded 0.256

This result reflected the main effect of HBOT on tissue repair depending on increasing oxygen saturation but the main effect of LLLT needs more investigation. Further studies are recommended to investigate the effects of LLLT on oxygen saturation and the effects of combined therapy between HBOT and LLLT on rapid healing action for chronic ischemic ulcers.

Improving the microcirculation and increasing transcutanous oxygen saturation to the ulcer region with hyperbaric Oxygen therapy was more than low level laser therapy.

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