The impact of topical phenytoin on recalcitrant neuropathic diabetic foot ulceration

Journal of wound care - Tập 18 Số 1 - Trang 33-37 - 2009
Mamdouh El-Nahas1, Hanan Gawish1, Manal Tarshoby1, O. State1
1members of the Diabetic foot team, Diabetes and Endocrinology Unit, Mansoura University, Egypt.

Tóm tắt

Objective: To study the impact of topical phenytoin on the healing of recalcitrant neuropathic diabetic foot ulcers in patients with no clinical evidence of ischaemia or infection, and to evaluate its antibacterial effect. Method: Thirty-two patients were enrolled into the study. Topical phenytoin in the form of 2% aerosol powder was applied once daily in addition to the patient's usual treatment (weekly sharp debridement, offloading and use of a gauze dressing) for eight weeks. The primary outcome was change in ulcer area over time, measured by grid tracing. Secondary outcomes were the ability of topical phenytoin to eradicate bacterial isolates, and the occurrence of adverse events. Results: Topical phenytoin significantly improved healing of recalcitrant neuropathic diabetic foot ulcers. Baseline wound area was 319.3 ± 340.4mm2, reducing to 286.1 ± 341.1mm2 and 269.1 ± 341.2mm2 after four and eight weeks respectively. However, the overall reduction in ulcer size was only 18.3% ± 27.5% and 25.7% ± 38.6 % respectively. Topical phenytoin therapy over eight weeks did not eradicate any of the bacterial wound isolates (Staphylococcus spp., Proteus spp. or Pseudomonas spp.). Of the 32 patients evaluated, only eight (25%) achieved more than 50% reduction in ulcer size after eight weeks of treatment. Conclusion: Topical phenytoin can enhance wound healing in recalcitrant neuropathic diabetic foot ulcers, although only one-quarter of patients achieved more than 50% reduction in ulcer size after eight weeks of therapy. Further research is needed to characterise those patients who will satisfactorily respond to such therapy. Declaration of interest: None.

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Thông tin
Thông tin xuất bản

Journal of wound care

Tập 18 Số 1

33-37

Thông tin tác giả