title: [Therapeutic superiority of regional retrograde venous antibiotic pressure infusion versus systemic venous infusions in diabetic patients with infected neuropathic plantar ulcers].
abstract: Since systemic treatment of neuropathic plantar ulcers in diabetics (DNPU) has so far been rather ineffective, recent reports of successful management of DNPU by short-term retrograde transvenous leg perfusion (RVP) by South American angiologists encouraged us to apply this treatment method in diabetics suffering from chronic DNPU. Hence, in a prospective comparative clinical trial started in 1989 we have treated 45 male diabetics suffering from DNPU with the same daily doses of netilmycin, administered either in systemic venous infusions (SVI: n = 21, three times/day) or in RVP (n = 24, once/day). After 10 consecutive days of treatment, ulcers had closed in 8 of the 24 patients treated with RVP, as against 3 of the 21 treated with SVI. Diminution of the ulcer area by > 30% including full debridement was achieved in 10/24 of the RVP cases (SVI: 4/21). During 6 months of follow-up, amputation of toes or forefoot was necessary in only 1 patient in the RVP group, but in 4 in the SVI group. Partial restitution of osteolytic damage was observed in some cases after RVP. Our results show that regional netilmycin therapy given by the RVP procedure is clearly superior to equal netilmycin doses administered by SVI for the treatment of DNPU. RVP can be recommended in DNPU, particularly when the ulcers are complicated by infections.
authors.affiliation: Dermatologische Klinik, Universität Erlangen-Nürnberg.
authors.forename: C
authors.initials: C
authors.lastname: Seidel
authors.forename: S
authors.initials: S
authors.lastname: Bühler-Singer
authors.forename: J
authors.initials: J
authors.lastname: Tacke
authors.forename: O P
authors.initials: OP
authors.lastname: Hornstein
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D017719:Diabetic Foot / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D014945:Wound Healing / Q000187:drug effects; D014946:Wound Infection / Q000188:drug therapy*
chemical_list: D009428:Netilmicin
vernacular_title: Therapeutische Uberlegenheit regionaler retrograd-venöser Antibiotika-Druckperfusionen versus systemisch-venöser Infusionen bei Diabetikern mit infizierten neuropathischen Plantarulcera.