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Thermography confirms improvement of wound healing by water-filtered infrared-A (wIRA)

22.10.2008
Water-filtered infrared-A (wIRA) as a special form of heat radiation can enable and improve wound healing in non-healing chronic venous stasis ulcers. wIRA can considerably alleviate the pain and diminish an elevated wound exudation and inflammation. wIRA increases temperature, oxygen partial pressure, and perfusion in the tissue.

In an original paper, just published in the interdisciplinary medical e-Journal "GMS German Medical Science" of the Association of the Scientific Medical Societies in Germany (AWMF), the beneficial effects of wIRA in chronic venous stasis ulcers could be demonstrated by clinical assessments and as well by extensive thermographic investigations.

It is estimated that at least 1% of the population in industrialised countries will suffer from leg ulcer at some time. A prospective study of the University Tromsø/Norway and the Hospital in Hillerød/Denmark of 10 patients with non-healing chronic venous stasis ulcers of the lower legs, in which other therapies were not successful, resulted under therapy with wIRA in a complete or almost complete wound healing (96-100% reduction of wound area) in 7 of 10 patients and a reduction of the ulcer size in another 2 of 10 patients. The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes. Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer was achieved).

An example of a successful course of therapy with wIRA irradiation is demonstrated in Figure 1 with normal view, thermographic image and temperature profile across the ulcer, in each case before therapy and after completion of therapy.

Among the 6 patients without concomitant problems (peripheral occlusive arterial disease, smoking or lacking compression garment therapy) a complete or almost complete wound healing was achieved without any exception. Even in the 4 patients with concomitant problems clear reductions of wound area were reached in 4 of the 5 ulcers including one complete wound closure. In one patient a randomized controlled side comparison was possible (therapy of one leg with an ulcer with wIRA and visible light, therapy of the other leg with another ulcer with a control group radiator, emitting only visible light without wIRA) and revealed marked differences in favour of wIRA.

In addition the study showed under therapy with wIRA a clear reduction of pain and required pain medication (e.g. from 15 to 0 pain tablets per day) and a normalization of the thermographic image. Prior to the start of therapy typically the rim of the ulcer was hyperthermic, accompanied with a relative hypothermic ulcer base, partly associated with up to 4.5°C temperature gradiance. At the end of the course of therapy the temperature differences were mostly balanced. All assessments using visual analogue scales (VAS: pain sensation of the patient in the wound area, overall rating of the effect of the irradiation by the patient and by the clinical investigator, overall assessment of the feeling of the patient of the wound area, overall evaluation of the wound healing process by the clinical investigator, overall assessment of the cosmetic appearance by the patient and by the clinical investigator) improved remarkably during the period of irradiation therapy and commensurated with the improvement of the quality of life.

Wound healing and infection defence depend decisively on a sufficient supply with energy and oxygen. The central portion of chronic wounds is often clearly hypoxic and relatively hypothermic - as thermographically shown in the study -, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. wIRA produces a therapeutically usable field of heat in the tissue and increases tissue temperature, tissue oxygen partial pressure, and tissue perfusion. These three factors are vital for a sufficient tissue supply with energy and oxygen. The good clinical effect of wIRA on wounds and wound infections can be explained by the improvement of both the energy supply per time (increase of metabolic rate) and the oxygen supply. In addition wIRA has non-thermal and non-thermic effects, which are based on putting direct stimuli on cells and cellular structures.

Publication:

Mercer JB, Nielsen SP, Hoffmann G. Improvement of wound healing by water-filtered infrared-A (wIRA) in patients with chronic venous stasis ulcers of the lower legs including evaluation using infrared thermography. GMS Ger Med Sci. 2008;6:Doc11.
Online available from: http://www.egms.de/pdf/gms/2008-6/000056.pdf (PDF) and http://www.egms.de/en/gms/2008-6/000056.shtml (HTML).

The freely available publication includes 10 patient appendices and 2 video sequences.

Wolfgang Müller | idw
Further information:
http://awmf.org
http://www.egms.de/en/gms/2008-6/000056.shtml
http://www.egms.de/pdf/gms/2008-6/000056.pdf

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