Physical medicine modalities most frequently applied in the lower limbs chronic wounds treatment in Poland
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Department of Physical Medicine, Chair of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Poland
Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
Grzegorz Onik   

Department of Physical Medicine, Chair of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 12, 40-752 Katowice, Poland. Tel./fax: +48 32 208 87 12.
Submission date: 2015-12-20
Acceptance date: 2016-09-06
Online publication date: 2017-01-12
Publication date: 2019-12-15
Pol. Ann. Med. 2017;24(1):92–98
Chronic wounds are the ones that present no healing progress for more than three months. The most common reasons for the chronic wound development in the lower limbs include long-lasting diabetes mellitus, venous insufficiency and peripheral arterial disease. However, it is estimated that 15%–20% of the lower limb chronic wounds are of mixed etiology. Standard treatments such as pharmacotherapy, debridement or skin grafting may be supplemented with physical medicine modalities.

The aim of the paper was to indicate the utility and biological effects of the physical medicine modalities frequently applied in chronic wound treatment.

The physical medicine modalities widely used in the lower limbs chronic wounds treatment are variable magnetic fields, low-level laser therapy and hyperbaric oxygen therapy. Those modalities are proved to stimulate various biological reactionswhich may promote chronic wound healing. Stimulation of angiogenesis and collagen proliferation are factors that promote histological wound maturation and closure. Local circulation improvement mediated by hypocoagulation and vasodilatation is a factor accelerating wounds healing. Modalities-mediated pain reduction is a result of anti-inflammatory activity as well as of endogenous endorphin secretion. Modalities-mediated bacteriostatic and bactericidal effects are also observed. All those effects are mediated by activation of the immune system. An anti-inflammatory effect is due to the inhibition of pro-inflammatory cytokines secretion and the increase in interleukins activity.

Variable magnetic fields, low-level laser therapy and hyperbaric oxygen therapy are modalities revealing various working mechanisms. The significance of their administration in chronic wounds treatment can be attributed to a variety of their biological effects.

None declared.
McDaniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Cont Nurs. 2014;41(5):415–423.
Arya AK, Tripathi R, Kumar S, Tripathi K. Recent advances on the association of apoptosis in chronic non healing diabetic wound. World J Diabetes. 2014;5(6):756–762.
Rüttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M. Local treatment of chronic wounds: in patients with peripheral vascular disease, chronic venous insufficiency, and diabetes. Dtsch Arztebl Int. 2013;110(3):25–31.
Au TB, Golledge J, Walker PJ, Haigh K, Nelson M. Peripheral arterial disease – diagnosis and management in general practice. Aust Fam Physician. 2013;42(6):397–400.
Rac-Albu M, Iliuta L, Guberna SM, Sinescu C. The role of ankle-brachial index for predicting peripheral arterial disease. Maedica (Buchar). 2014;9(3):295–302.
Valdivielso P, Ramírez-Bollero J, Pérez-López C. Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link? World J Diabetes. 2014;5(5):577–585.
Thukkani AK, Kinlay S. Endovascular intervention for peripheral artery disease. Circ Res. 2015;116(9):1599–1613.
Whayne TF. A review of the role of anticoagulation in the treatment of peripheral arterial disease. Int J Angiol. 2012;21(4):187–194.
Swaminathan A, Vemulapalli S, Patel MR, Jones WS. Lower extremity amputation in peripheral artery disease: improving patient outcomes. Vasc Health Risk Manage. 2014;10:417–424.
Hiatt WR, Rogers RK, Brass EP. The treadmill is a better functional test than the 6-minute walk test in therapeutic trials of patients with peripheral artery disease. Circulation. 2014;130(1):69–78.
Kharroubi AT, Darwish HM. Diabetes mellitus: the epidemic of the century. World J Diabetes. 2015;6(6):850–867.
Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes. World J Diabetes. 2015;6(7):961–969.
Surani S, Brito V, Surani A, Ghamande S. Effect of diabetes mellitus on sleep quality. World J Diabetes. 2015;6(6):868–873.
Fujimaki S, Wakabayashi T, Takemasa T, Asashima M, Kuwabara T. Diabetes and stem cell function. Biomed Res Int. 2015;2015:592915.
Turan Y, Ertugrul BM, Lipsky BA, Bayraktar K. Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers? World J Exp Med. 2015;5(2):130–139.
Meloni M, Izzo V, Vainieri E, Giurato L, Ruotolo V, Uccioli L. Management of negative pressure wound therapy in the treatment of diabetic foot ulcers. World J Orthop. 2015;6(4):387–393.
Tang UH, Zügner R, Lisovskaja V, Karlsson J, Hagberg K, Tranberg R. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers. Diabet Foot Ankle. 2015;6:27593.
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37–53.
Chiwanga FS, Njelekela MA. Diabetic foot: prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania – a cross-sectional study. J Foot Ankle Res. 2015;8:20.
Suresh DH, Suryanarayan S, Sarvajnamurthy S, Puvvadi S. Treatment of a non-healing diabetic foot ulcer with platelet-rich plasma. J Cutan Aesthet Surg. 2014;7(4):229–231.
Vasudevan B. Venous leg ulcers: pathophysiology and classification. Indian Dermatol Online J. 2014;5(3):366–370.
Scotton MF, Miot HA, Abbade LP. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort. An Bras Dermatol. 2014;89(3):414–422.
Wachholz PA, Masuda PY, Nascimento DC, Taira CM, Cleto NG. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil. An Bras Dermatol. 2014;89(1):73–81.
Rai R, Mysore V. Venous leg ulcer. Indian Dermatol Online J. 2014;5(3):364–365.
Shenoy MM. Prevention of venous leg ulcer recurrence. Indian Dermatol Online J. 2014;5(3):386–389.
Kirsner RS, Baquerizo Nole KL, Fox JD, Liu SN. Healing refractory venous ulcers: new treatments offer hope. J Invest Dermatol. 2015;135(1):19–23.
Honorato-Sampaio K, Guedes AC, Lima VL, Borges EL. Bacterial biofilm in chronic venous ulcer. Braz J Infect Dis. 2014;18(3):350–351.
Hussain SM. A comparison of the efficacy and cost of different venous leg ulcer dressings: a retrospective cohort study. Int J Vasc Med. 2015;2015:187531.
Sussman G. Ulcer dressings and management. Aust Fam Physician. 2014;43(9):588–592.
Vishwanath V. Quality of life: venous leg ulcers. Indian Dermatol Online J. 2014;5(3):397–399.
Serra R, Gallelli L, Conti A, et al. The effects of sulodexide on both clinical and molecular parameters in patients with mixed arterial and venous ulcers of lower limbs. Drug Des Dev Ther. 2014;8:519–527.
Humphreys ML, Stewart AH, Gohel MS, Taylor M, Whyman MR, Poskitt KR. Management of mixed arterial and venous leg ulcers. Br J Surg. 2007;94(9):1104–1107.
Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J Vasc Surg. 2012;55(1):122–128.
Zhang Z, Lv L, Guan S. Wound bed preparation for ischemic diabetic foot ulcer. Int J Clin Exp Med. 2015;8(1):897–903.
Ismail I, Dhanapathy A, Gandhi A, Kannan S. Diabetic foot complications in a secondary foot hospital: a clinical audit. Australas Med J. 2015;8(4):106–112.
Hadadi A, Omdeh Ghiasi H, Hajiabdolbaghi M, Zandekarimi M, Hamidian R. Diabetic foot: infections and outcomes in Iranian admitted patients. Jundishapur J Microbiol. 2014;7(7):e11680.
Weller C, Evans S. Venous leg ulcer management in general practice – practice nurses and evidence based guidelines. Aust Fam Physician. 2012;41(5):331–337.
Nair B. Compression therapy for venous leg ulcers. Indian Dermatol Online J. 2014;5(3):378–382.
Nair B. Venous leg ulcer: systemic therapy. Indian Dermatol Online J. 2014;5(3):374–377.
Dogra S, Rai R. Venous leg ulcer: topical treatment, dressings and surgical debridement. Indian Dermatol Online J. 2014;5(3):371–373.
Walker CM, Bunch FT, Cavros NG, Dippel EJ. Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease. Clin Interv Aging. 2015;10:1147–1153.
Zwolińska J. Physical therapy as part of physiotherapy. Prz Med Uniw Rzesz Inst Leków. 2011;3:278–286 [in Polish].
Straburzyńska-Lupa A, Straburzyński G. History of balneotherapy and physiotherapy in Wielkopolska. Acta Balneol. 2014;56(4):228–233 [in Polish].
Pasek J, Mucha R, Sieroń A. Magnetoledotherapy in treatment of pain rheumatoid arthritis of the knee. Acta Bio-Opt Inf Med Biomed Eng. 2006;3(12):189–191 [in Polish].
Woldańska-Okońska M, Czernicki J. Effect of low frequency magnetic fields used in magnetotherapy and magnetostimulation on the rehabilitation results of patients after ischemic stroke. Przegl Lek. 2007;64(2):74–77 [in Polish].
Cieślar G, Nowak M, Kawecki M, Glinka M, Sieroń A. Application of variable magnetic fields in the treatment of wounds. Leczenie Ran. 2005;2(4):99–106 [in Polish].
Mucha R, Mucha M, Budziosz J, Sieroń A. Clinical applications of magnetic fields in synergy with low power light. Now Lek. 2010;79(3):167–172 [in Polish].
Sieroń A, Glinka M. The influence of magnetic fields in therapeutic parameters on the healing process of skin and soft tissues. Chir Pol. 2002;4(4):153–158 [in Polish].
Tepper OM, Callaghan MJ, Chang EI, et al. Electromagnetic fields increase in vitro and in vivo angiogenesis through endothelial release of FGF-2. FASEB J. 2004;18(11):1231–1233.
Kowal P, Marcinkowska-Gapińska A. The influence of alternating magnetic field stimulation on the results of thermographic examination. Neuroskop. 2005;7:135–138 [in Polish].
Sieroń A, Cieślar G, eds. Magnetic Fields and Light in Medicine and Physiotherapy. Bielsko-Biała: Alfa-Media Press; 2013 [in Polish].
Weledji EP, Fokam P. Treatment of the diabetic foot – to amputate or not? BMC Surg. 2014;14:83.
Sieroń A, Cieślar G, Biniszkiewicz T. Therapy with use of ELF variable magnetic fields – a new possibility in a treatment of diabetes? Diabetol Dośw Klin. 2003;3(4):299–306 [in Polish].
Ross CL, Harrison BS. The use of magnetic field for the reduction of inflammation: a review of the history and therapeutic results. Altern Ther Health Med. 2013;19(2):47–54.
Pasek J, Mucha R, Sieroń A. Ulcera crurum: treatment with low frequency magnetic field stimulation with high energy LEDs. Description of case. Acta Bio-Opt Inf Med Biomed Eng. 2006;1(12):15–17 [in Polish].
Wróbel M, Szymborska-Kajanek A, Karasek D, et al. Influence of alternating low frequency – magnetic fields in patients with diabetic polyneuropathy – pilot study. Diabetol Dośw Klin. 2005;5(1):59–63 [in Polish].
Pasek J, Misiak A, Mucha R, Pasek T, Sieroń A. New possibilities in physiotherapy – magnetolaserotherapy. Fizjoter Pol. 2008;1(4):1–10 [in Polish].
Farivar S, Malekshahabi T, Shiari R. Biological effects of low level laser therapy. J Lasers Med Sci. 2014;5(2):58–62.
Avci P, Gupta A, Sadasivam M, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg. 2013;32(1):41–52.
Ebrahimi T, Moslemi N, Rokn A, Heidari M, Nokhbatolfoghahaie H, Fekrazad R. The influence of lowintensity laser therapy on bone healing. J Dent (Tehran). 2012;9(4):238–248.
Fabre HS, Navarro RL, Oltramari-Navarro PV, et al. Antiinflammatory and analgesic effects of low-level laser therapy on the postoperative healing process. J Phys Ther Sci. 2015;27(6):1645–1648.
de Loura Santana C, Silva Dde F, Deana AM, et al. Tissue responses to postoperative laser therapy in diabetic rats submitted to excisional wounds. PLOS ONE. 2015;10(4):e0122042.
de Lima FJ, Barbosa FT, de Sousa-Rodrigues CF. Use alone or in combination of red and infrared laser in skin wounds. J Lasers Med Sci. 2014;5(2):51–57.
Góralczyk K, Szymańska J, Łukowicz M, et al. Effect of LLLT on endothelial cells culture. Lasers Med Sci. 2015;30(1):273–278.
Rola P, Doroszko A, Derkacz A. The use of low-level energy laser radiation in basic and clinical research. Adv Clin Exp Med. 2014;23(5):835–842.
Brune K, Patrignani P. New insights into the use of currently available non-steroidal anti-inflammatory drugs. J Pain Res. 2015;8:105–118.
Terzuoli E, Meini S, Cucchi P, et al. Antagonism of bradykinin B2 receptor prevents inflammatory responses in human endothelial cells by quenching the NF-kB pathway activation. PLoS ONE. 2014;9(1):e84358.
Furquim RD, Pascotto RC, Rino Neto J, Cardoso JR, Ramos AL. Low-level laser therapy effects on pain perception related to the use of orthodontic elastomeric separators. Dental Press J Orthod. 2015;20(3):37–42.
Park IS, Chung PS, Ahn JC. Enhancement of ischemic wound healing by spheroid grafting of human adiposederived stem cells treated with low-level light irradiation. PLOS ONE. 2015;10(6):e0122776.
Kingsley JD, Demchak T, Mathis R. Low-level laser therapy as a treatment for chronic pain. Front Physiol. 2014;5:306.
Tomimura S, Silva BP, Sanches IC, et al. Hemodynamic effect of laser therapy in spontaneously hypertensive rats. Arq Bras Cardiol. 2014;103(2):161–164.
Morimoto Y, Saito A, Tokuhashi Y. Low level laser therapy for sports injuries. Laser Ther. 2013;22(1):17–20.
Colombo F, Neto Ade A, Sousa AP, Marchionni AM, Pinheiro AL, Reis SR. Effect of low-level laser therapy (l 660 nm) on angiogenesis in wound healing: a immunohistochemical study in a rodent model. Braz Dent J. 2013;24(4):308–312.
Gross AR, Dziengo S, Boers O, et al. Low level laser therapy (LLLT) for neck pain: a systematic review and metaregression. Open Orthop J. 2013;7:396–419.
Kilík R, Lakyová L, Sabo J, et al. Effect of equal daily doses achieved by different power densities of low-level laser therapy at 635 nm on open skin wound healing in normal and diabetic rats. Biomed Res Int. 2014;2014:269253.
Beckmann KH, Meyer-Hamme G, Schröder S. Low level laser therapy for the treatment of diabetic foot ulcers: a critical survey. Evid Based Complement Alternat Med. 2014;2014:626127.
Andrade Fdo S, Clark RM, Ferreira ML. Effects of low-level laser therapy on wound healing. Rev Col Bras Cir. 2014;41(2):129–133.
Calisto FC, Calisto SL, Souza AP, França CM, Ferreira AP, Moreira MB. Use of low-power laser to assist the healing of traumatic wounds in rats. Acta Cir Bras. 2015;30(3):204–208.
Hodjati H, Rakei S, Johari HG, Geramizedeh B, Sabet B, Zeraatian S. Low-level laser therapy: an experimental design for wound management: a case-controlled study in rabbit model. J Cutan Aesthet Surg. 2014;7(1):14–17.
Melo VA, Anjos DC, Albuquerque Júnior R, Melo DB, Carvalho FU. Effect of low level laser on sutured wound healing in rats. Acta Cir Bras. 2011;26(2):129–134.
Nussbaum EL, Heras FL, Pritzker KP, Mazzulli T, Lilge L. Effects of low intensity laser irradiation during healing of infected skin wounds in the rat. Photonics Lasers Med. 2014;3(1):23–36.
Lipovsky A, Nitzan Y, Gedanken A, Lubart R. Visible lightinduced killing of bacteria as a function of wavelength: implication for wound healing. Lasers Surg Med. 2010;42(6):467–472.
Silva DC, Plapler H, Costa MM, Silva SR, Sá Mda C, Silva BS. Low level laser therapy (AlGaInP) applied at 5J/cm2 reduces the proliferation of Staphylococcus aureus MRSA in infected wounds and intact skin of rats. An Bras Dermatol. 2013;88(1):50–55.
Chaves ME, Araújo AR, Piancastelli AC, Pinotti M. Effects of low-power light therapy on wound healing: LASER LED. An Bras Dermatol. 2014;89(4):616–623.
Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012;40(2):516–533.
Tuk B, Tong M, Fijneman EM, van Neck JW. Hyperbaric oxygen therapy to treat diabetes impaired wound healing in rats. PLoS ONE. 2014;9(10):e108533.
Stoekenbroek RM, Santema TB, Legemate DA, Ubbink DT, van den Brink A, Koelemay MJ. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014;47(6):647–655.
Shah J. Hyperbaric oxygen therapy. J Am Col Certif Wound Spec. 2010;2(1):9–13.
Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plast Surg. 2012;45(2):316–324.
Kulikovsky M, Gil T, Mettanes I, Karmeli R, Har-Shai Y. Hyperbaric oxygen therapy for non-healing wounds. Isr Med Assoc J. 2009;11(8):480–485.
Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011;127(suppl 1):131S–141S.
Thom SR. Oxidative stress is fundamental to hyperbaric oxygen therapy. J Appl Physiol (1985). 2009;106(3):988–995.