Laser therapy for venous leg ulcers

Background

Around one percent of people in industrialised countries will suffer from a leg ulcer at some time. The majority of these leg ulcers are due to problems in the veins, resulting in an accumulation of blood in the legs. Leg ulcers arising from venous problems are called venous (varicose or stasis) ulcers. The main treatment is a firm compression garment (bandage or stocking) in order to help the blood return back up the leg. Compression, however, does not heal all ulcers, and other treatments, such as the local application of energy from low-level lasers, are sometimes used. It is unclear whether low-level laser therapy accelerates the healing of venous leg ulcers, and if it does, whether any particular treatment regimen is optimal.

Objectives

To assess the effectiveness of low level laser therapy in the treatment of venous leg ulcers.

Search strategy

Searches of 19 databases, hand searching of journals and conference proceedings from 1948 onwards, and examination of bibliographies.

Selection criteria

Randomised controlled trials (RCTs) comparing low level laser therapy with: sham laser; no laser. There was no restriction on date or language. The main outcome measure used was complete healing of the ulcers.

Data collection and analysis

Data extraction was done by one reviewer and checked by a second. Meta analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar.

Main results

There were four eligible trials. Two RCTs compared laser therapy with sham, one with ultraviolet therapy and one with non-coherent, unpolarised red light.

Neither of the two RCTs comparing laser with sham found a significant difference in healing rates; there was no significant benefit for laser evident when the trials were pooled (88 patients in total).

A three-arm study (45 patients) compared:
- laser therapy alone
- laser therapy plus infrared light
- non-coherent, unpolarised red light.
Significantly more ulcers completely healed in the group receiving a combination of laser and infrared light compared with non-coherent, unpolarised red light.

A fourth trial (6 patients) compared laser and ultraviolet light and found no significant difference.

Authors' conclusions

We have found no evidence of any benefit associated with low level laser therapy on venous leg ulcer healing. One small study suggests that a combination of laser and infrared light may promote the healing of venous ulcers, however more research is needed.