A comparative study of topical phenytoin with conventional dressing in grade I and II diabetic foot ulcers.pptx

Comparative study

1. A comparative study of topical phenytoin with conventional dressing in grade I and II diabetic foot ulcers . PRESENTER: DR Anil R SECOND YEAR PG DEPARTMENT OF GENERAL SURGERY GIMS UNDER THE GUIDANCE OF : DR Sunil Ramappa Telkar ASSOCIATE PROFESSOR DEPARTMENT OF GENERAL SURGERY GIMS

2. INTRODUCTION: Diabetic foot ulcer is the most common and preventable complication . Prevalence of diabetic foot ulcer in clinical population is 3.61 %. Diabetic foot ulcer precedes maximum number of amputat ions in India almost 85%.

3. The management of diabetic foot requires a multisystem approach and is largely determined by its : Glycemic control Severity or grade Vascularity of limb The presence of infection and bacterial load. Location of the wound Nutritional status

4. Phenytoin ( diphenyl hydantoin ) Introduced for the effective control of convulsive disorders . A common side effect with systemic phenytoin treatment is the development of fibrous overgrowth of gingiva. The stimulatory effect of phenytoin on connective tissue suggested the possibility for its use in wound healing.

5. The mechanism of action of Phenytoin : Stimulating fibroblast proliferation Enhancing the rate of formation of granulation tissue Neovascularization Reducing collagenase activity Hastening deposition of collagen Decreasing bacterial load Decreasing wound exudates Increases gene expression of the platelet derived growth factor beta chain in macrophage and monocytes.

6. AIMS AND OBJECTIVES OF THE STUDY To compare the efficacy of topical phenytoin with that of conventional wound care in healing of diabetic ulcer in terms of Rate of granulation tissue formation. Rate of reduction in the mean ulcer surface area. Duration of hospital stay.

7. METHODS A sample of 50 patients was selected and written informed consent was obtained. All patients underwent general physical and clinical examination for peripheral vascular status and peripheral neuropathic changes in the lower extremities. After satisfying the inclusion and exclusion criteria, the selected patients were randomly assigned into 2 groups. In each patient one ulcer was chosen and surgical debridement was done when necessary.

8. After slough removal, the surface area was measured. Phenytoin sodium capsules were powdered and sprinkled over the ulcer. Sterile gauze was soaked in the 0.9% normal saline and placed over the wound. Conventional dressing was done with 5%w/v povidone iodine solution. Dressing was done on alternate days. Wound culture and sensitivity were obtained.

9. The quantity of powder dusted depends on the surface area. Surface area (in cm 2 ) Dose (in mg) 0 to 5 100 5 to 10 150 10 to 15 200 >15 300

10. INCLUSION CRITERIA: Grade I and II foot ulcers according to Meggit -Wagner classification . Ulcer surface area ≤ 15cm 2 .

11. EXCLUSION CRITERIA : Grade III, IV and V foot ulcers according to Meggit -Wagner classification. Ulcer surface area greater than15cm 2 Diabetes mellitus with gangrenous changes. Wounds with osteomyelitis. Patients with allergy to phenytoin. Peripheral vascular disease. Other co-morbid conditions like renal failure, generalized debility affect wound healing

12. RESULTS: 1. AGE DISTRIBUTION OF THE STUDY POPULATION: AGE BETADINE PHENYTOIN 31-40 6 4 41-50 10 8 51-60 6 9 61-70 3 2 71-80 2

13. 2 . SEX DISTRIBUTION: SEX NUMBER PERCENTAGE FEMALE 06 12% MALE 44 88%

14. 3. MEAN ULCER SURFACE AREA GROUP MEAN ULCER SURFACE AREA BETADINE 12.8 cm2 PHENYTOIN 13.4 cm2

15. 4. MICROBIOLOGICAL STUDY CULTURE BETADINE PHENYTOIN TOTAL POSITIVE 22 23 45 NEGATIVE 03 02 05

16. 5. SITE OF LESION SITE OF LESION NO: OF PATIENTS PERCENTAGE LEG 12 24 DORSUM OF FOOT 14 28 SOLE 11 22 TOES 13 26

17. 6. RATE OF GRANULATION TISSUE FORMATION GROUP RATE OF GRANULATION TISSUE FORMATION BETADINE 88.8 % PHENYTOIN 97.4 %

18. 7. RATE OF REDUCTION IN ULCER SURFACE AREA BETADINE PHENYTOIN MEAN REDUCTION ON DAY 7 24.8 % 51.4 % MEAN REDUCTION ON DAY 14 48.2 % 78.6 %

19. GROUP FREQUENCY > 50% REDUCTION IN ULCER AREA ON DAY 14 PERCENTAGE BETADINE 25 09 36 % PHENYTOIN 25 22 88 %

20. 8. CULTURE SENSITIVITY REPORT ON DAY 14 CULTURE BETADINE PHENYTOIN POSITIVE 7 (28%) 2 (8%) NEGATIVE 18 (72 %) 23 (92%)

21. 9. DURATION OF HOSPITAL STAY GROUP MEAN NUMBER OF DAYS OF HOSPITAL STAY BETADINE 34.6 PHENYTOIN 26.2

22. DISCUSSION In the Phenytoin group, the mean rate of healthy granulation tissue formation was 97.4%, and mean hospital stay was 26.2 days compared to conventional wound dressing in which the mean rate of healthy granulation tissue formation and mean hospital stay was 68 .8% and 34.6 days respectively.

23. CONCLUSION Topical phenytoin helps in faster healing of the diabetic ulcer, reduces hospital stay and is superior to conventional wound dressing.