Title: A Prospective Comparative Study of Topical Phenytoin v/s Conventional Dressing for Diabetic Foot Ulcers
Authors: A. Silodia, Saket Narnoli, H.K Damde
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.55
Abstract
Introduction: Diabetic Foot Ulcer (DFU) is a common cause of morbidity in India and is estimated to affect 15% of all diabetic individuals during their life time. Its prevalence in clinical population is 3.61% and precedes almost 85% of amputation. Though many modalities of dressing have been described for such patients but they are quite costly for patients coming to our setup.
Aims & Objectives
- To evaluate the effectiveness of phenytoin as methods of dressing in treatment of Diabetic Foot Ulcer.
- To compare the results of topical phenytoin dressing v/s conventional dressing using Eusol & Betadine (povidone iodine )
Material & Methodology: 50 patients were taken in study & randomly divided into two groups of equal size with ulcer size (<5% TBSA) and depth (TEXAS grade 1) as the only selection criteria. Group I was treated with topical phenytoin 20mg/cm2 and Group II with conventional dressing of eusol and povidone iodine.
Daily dressing with oral antibiotics was given in both groups.
Parameters studies were:
a) Presence of Healthy Granulation Tissue (HGT) on Day14.
b) Mean Reduction in Percentage of Ulcer Area on Day 7 & Day 14.
c) > 50% reduction of ulcer area on Day 14.
Observation: In our study we found that there was a significant difference between the two groups in all three parameters we studies in favor of study group.
Presence of HGT on Day14: 86.95 % v/s 48% (p= 0.004)
Mean Reduction in ulcer area on day 7 &14: 41.38 & 68.17 v/s 24.56 & 47.85
(p < 0.001)
>50% reduction in ulcer area on Day 14: 62% v/s 38% (p= 0.004).
Conclusion: It can be concluded that Phenytoin for healing of DFU is an acceptable alternative to conventional method. It is safe, easily available, easy to apply and in expensive.
References
- Ahmed AM. History of diabetes mellitus. Saudi Med J. 2002;23:373–8.
- Nalini S, David G, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA.2005;293:217–28.
- Reiber GE, Vileikyte L, Boyko EJ, del AM, Smith DG, Lavery LA, et al. Causal pathways for incident lower extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22:157–62.
- American Diabetes Association. Consensus development conference on diabetic foot wound care.Diabetes Care. 1999;22:1354– 60.
- Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. AmFam Physician. 1998;57:1325–32.
- Frykberg RG. Diabetic foot ulcerations. In: Frykberg RG, editor. The high risk foot in diabetes mellitus.New York: Churchill Livingstone; 1991. pp. 151–95.
- Frykberg RG. Diabetic foot ulcers: current concepts. J Foot Ankle Surg. 1998;37:440–6.
- Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, et al. Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg. 2000;39(5 Suppl):S1–60.
- White R, McIntosh C. Topical therapies for diabetic foot ulcers: standard treatments. J Wound Care.2008;17:426–32