Epidermal growth factor intralesional infiltrations can prevent amputation in patients with advanced diabetic foot wounds.
This study examined if a series of epidermal growth factor (EGF) local infiltrations can enhance the healing process of complicated diabetic wounds. Twenty-nine in-hospital patients with diabetic neuropathic or ischaemic lesions with high risk of amputation were treated in a non controlled pilot study conducted at the National Institute of Angiology, Havana. Lesions, classified as Wagner's grade 3 or 4, included ulcers > or = 20 cm2 for > or = 25 days or amputation residual bases > or = 30 cm2 for > or = 15 days, healing refractory despite comprehensive wound care. EGF (25 microg) intralesional infiltrations (approximately 250 microl of a 25 microg/ml solution/injection point) were performed thrice weekly up to the eighth week. Wound closure was monitored during the treatment and recurrence examined for a year following discharge from hospital. Eighty-six per cent of the patients treated showed a productive granulation at infiltration session 8. Histological examination at this point indicated a substantial wound matrix transformation, granulation tissue cell repopulation and angiogenesis. Of the 29 patients treated, amputation was prevented in 17 (58.6%) of them who completed 24 infiltration sessions. They averaged 71.1 +/- 18.3% of reepithelisation during a mean in-hospital period of 66.5 +/- 4.9 days. Wound recurrence after 1 year of follow-up appeared in only one patient. Preliminary evidences suggest that EGF intralesional infiltrations may be effective in reducing diabetic lower limb amputation.
Acosta
Jorge Berlanga
JB
Division of Pharmaceutics, Center for Genetic Engineering and Biotechnology, Havana City, Cuba. Jorge.berlanga@cigb.edu.cu
Savigne
William
W
Valdez
Calixto
C
Franco
Neobalis
N
Alba
Jose S
JS
del Rio
Amaurys
A
López-Saura
Pedro
P
Guillén
Gerardo
G
Lopez
Ernesto
E
Herrera
Luís
L
Férnandez-Montequín
José
J
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003646:Debridement; D017719:Diabetic Foot / Q000188:drug therapy* / Q000601:surgery; D004815:Epidermal Growth Factor / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006097:Granulation Tissue / Q000187:drug effects / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014945:Wound Healing / Q000187:drug effects
D004815:Epidermal Growth Factor