title: Epidermal growth factor intralesional infiltrations can prevent amputation in patients with advanced diabetic foot wounds.
abstract: 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.
authors.affiliation: Division of Pharmaceutics, Center for Genetic Engineering and Biotechnology, Havana City, Cuba. Jorge.berlanga@cigb.edu.cu
authors.forename: Jorge Berlanga
authors.initials: JB
authors.lastname: Acosta
authors.forename: William
authors.initials: W
authors.lastname: Savigne
authors.forename: Calixto
authors.initials: C
authors.lastname: Valdez
authors.forename: Neobalis
authors.initials: N
authors.lastname: Franco
authors.forename: Jose S
authors.initials: JS
authors.lastname: Alba
authors.forename: Amaurys
authors.initials: A
authors.lastname: del Rio
authors.forename: Pedro
authors.initials: P
authors.lastname: López-Saura
authors.forename: Gerardo
authors.initials: G
authors.lastname: Guillén
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lopez
authors.forename: Luís
authors.initials: L
authors.lastname: Herrera
authors.forename: José
authors.initials: J
authors.lastname: Férnandez-Montequín
mesh_terms: 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
chemical_list: D004815:Epidermal Growth Factor