title: 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.
abstract: BACKGROUND
  Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects.
  
  
  OBJECTIVE
  prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up.
  
  
  METHODS
  10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun radiator type 501, 10 mm water cuvette, water-filtered spectrum 550-1400 nm) or visible light irradiation (VIS; only possible in one patient). The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm(2) wIRA and approximately 45 mW/cm(2) VIS). Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer). The main variable of interest was "percent change of ulcer size over time" including complete wound closure. Additional variables of interest were thermographic image analysis, patient's feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator), assessment of feeling of the wound area (by patient), assessment of wound healing (by clinical investigator) and assessment of the cosmetic state (by patient and by clinical investigator). For these assessments visual analogue scales (VAS) were used.
  
  
  RESULTS
  The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10 patients, a clear reduction of pain and pain medication consumption (e.g. from 15 to 0 pain tablets per day), and a normalization of the thermographic image (before the beginning of the therapy typically hyperthermic rim of the ulcer with relative hypothermic ulcer base, up to 4.5 degrees C temperature difference). In one patient the therapy of an ulcer of one leg was performed with the fully active radiator (wIRA(+VIS)), while the therapy of an ulcer of the other leg was made with a control group radiator (only VIS without wIRA), showing a clear difference in favour of the wIRA treatment. All mentioned VAS ratings improved remarkably during the period of irradiation treatment, representing an increased quality of life. Failures of complete or nearly complete wound healing were seen only in patients with arterial insufficiency, in smokers or in patients who did not have venous compression garment therapy.
  
  
  CONCLUSIONS
  wIRA can alleviate pain considerably (with an impressive decrease of the consumption of analgesics) and accelerate wound healing or improve a stagnating wound healing process and diminish an elevated wound exudation and inflammation both in acute and in chronic wounds (in this study shown in chronic venous stasis ulcers of the lower legs) and in problem wounds including infected wounds. In chronic recalcitrant wounds complete healing is achieved, which was not reached before. Other studies have shown that even without a disturbance of wound healing an acute wound healing process can be improved (e.g. reduced pain) by wIRA. wIRA is a contact-free, easily used and pleasantly felt procedure without consumption of material with a good penetration effect, which is similar to solar heat radiation on the surface of the earth in moderate climatic zones. Wound healing and infection defence (e.g. granulocyte function including antibacterial oxygen radical formation of the granulocytes) are critically dependent on a sufficient energy supply (and on sufficient oxygen). The good clinical effect of wIRA on wounds and also on problem wounds and wound infections can be explained by the improvement of both the energy supply and the oxygen supply (e.g. for the granulocyte function). wIRA causes as a thermal effect in the tissue an improvement in three decisive factors: tissue oxygen partial pressure, tissue temperature and tissue blood flow. Besides this non-thermal effects of infrared-A by direct stimulation of cells and cellular structures with reactions of the cells have also been described. It is concluded that wIRA can be used to improve wound healing, to reduce pain, exudation, and inflammation and to increase quality of life.
authors.affiliation: Department of Medical Physiology, Faculty of Medicine, University of Tromsø, Norway. james.mercer@fagmed.uit.no
authors.forename: James B
authors.initials: JB
authors.lastname: Mercer
authors.forename: Stig Pors
authors.initials: SP
authors.lastname: Nielsen
authors.forename: Gerd
authors.initials: G
authors.lastname: Hoffmann
references.citation: Dermatol Surg. 1998 Dec;24(12):1383-6
references.pmid: 9865208
references.citation: GMS Krankenhhyg Interdiszip. 2008 Mar 05;2(2):Doc52
references.pmid: 20204086
references.citation: Arch Dermatol. 1997 Oct;133(10):1231-4
references.pmid: 9382561
references.citation: Toxicol Lett. 2001 Apr 8;121(1):57-61
references.pmid: 11312037
references.citation: Int J Dermatol. 1999 May;38(5):380-6
references.pmid: 10369552
references.citation: Br J Surg. 2006 Aug;93(8):952-60
references.pmid: 16845694
references.citation: Proc Natl Acad Sci U S A. 2005 Apr 5;102(14):5050-5
references.pmid: 15790680
references.citation: Ger Med Sci. 2008 Jul 21;6:Doc08
references.pmid: 19675735
references.citation: Arch Surg. 2000 Jul;135(7):818-22
references.pmid: 10896376
references.citation: IEEE Eng Med Biol Mag. 2000 May-Jun;19(3):42-51
references.pmid: 10834115
references.citation: Photodermatol Photoimmunol Photomed. 2001 Dec;17(6):261-5
references.pmid: 11722751
references.citation: Ger Med Sci. 2007 Nov 14;5:Doc08
references.pmid: 19675716
references.citation: Lancet. 1999 Jul 3;354(9172):41-2
references.pmid: 10406365
references.citation: Surgery. 1981 Aug;90(2):262-70
references.pmid: 6166996
references.citation: Cochrane Database Syst Rev. 2000;(2):CD001182
references.pmid: 10796615
references.citation: J Invest Dermatol. 1998 Oct;111(4):629-33
references.pmid: 9764844
references.citation: IEEE Eng Med Biol Mag. 2000 May-Jun;19(3):28-9
references.pmid: 10834113
references.citation: Ann Surg. 1975 Jun;181(6):823-8
references.pmid: 1138632
references.citation: J Wound Care. 1999 Mar;8(3):111-4
references.pmid: 10362987
references.citation: Exp Dermatol. 2006 Feb;15(2):130-7
references.pmid: 16433685
references.citation: GMS Krankenhhyg Interdiszip. 2007 Dec 28;2(2):Doc54
references.pmid: 20204085
references.citation: Lancet. 2001 Sep 15;358(9285):876-80
references.pmid: 11567703
references.citation: Postgrad Med J. 2000 Nov;76(901):674-82
references.pmid: 11060140
references.citation: Adv Wound Care. 1999 Jan-Feb;12(1):35-40
references.pmid: 10326355
references.citation: Br J Clin Pharmacol. 1978 Jul;6(1):15-24
references.pmid: 666944
references.citation: Proc Natl Acad Sci U S A. 2002 Dec 10;99(25):16024-8
references.pmid: 12456879
references.citation: Ger Med Sci. 2005 Mar 04;3:Doc01
references.pmid: 19675718
references.citation: J Tissue Viability. 2002 Apr;12(2):67,  70, 72-4
references.pmid: 12001328
references.citation: J Photochem Photobiol B. 1999 Mar;49(1):1-17
references.pmid: 10365442
references.citation: Hautarzt. 2007 Nov;58(11):923-4
references.pmid: 17955204
references.citation: J Invest Dermatol. 2004 Nov;123(5):823-31
references.pmid: 15482467
references.citation: Lasers Surg Med. 2001;29(3):274-81
references.pmid: 11573231
references.citation: Int J Mol Med. 2000 Mar;5(3):247-51
references.pmid: 10677564
references.citation: Infection. 1985 Mar-Apr;13(2):52-6
references.pmid: 3838970
references.citation: Arch Surg. 2000 Nov;135(11):1293-7
references.pmid: 11074883
references.citation: GMS Krankenhhyg Interdiszip. 2007 Dec 28;2(2):Doc53
references.pmid: 20204084
references.citation: J Cell Biol. 1991 Aug;114(3):493-502
references.pmid: 1860881
references.citation: Lasers Surg Med. 2001;28(3):227-36
references.pmid: 11295757
references.citation: Cell Motil Cytoskeleton. 1994;27(3):262-71
references.pmid: 8020111
references.citation: Ger Med Sci. 2004 Oct 29;2:Doc08
references.pmid: 19675691
references.citation: Arch Dermatol Res. 1992;284(2):92-4
references.pmid: 1610218
references.citation: Pain. 2006 Sep;124(1-2):201-10
references.pmid: 16806710
references.citation: Adv Exp Med Biol. 1994;345:181-8
references.pmid: 8079706
references.citation: Pain. 1997 Aug;72(1-2):95-7
references.pmid: 9272792
references.citation: Arch Surg. 1997 Sep;132(9):997-1004; discussion 1005
references.pmid: 9301613