title: Efficacy of shellac, a natural product, for the prevention of wet gangrene.
abstract: OBJECTIVE
  To determine the effects of applying a natural polymer solution (shellac) to dry gangrene, and thereby prevent infection and progression to wet gangrene, in diabetic patients.
  
  
  METHODS
  This randomized, controlled, pilot study included patients with type 2 diabetes mellitus who had unreconstructable peripheral vascular disease and were awaiting autoamputation. Eligible patients were contraindicated for surgery, had a limited life expectancy and/or had refused surgical amputations. All patients received the best possible medical treatment and were randomized to receive either topical shellac or antiseptic application of 10% povidone-iodine (PVP-I) solution to gangrenous areas.
  
  
  RESULTS
  A total of 26 diabetic patients were eligible for inclusion, of whom 23 completed the study: 13 were treated with shellac and 10 with PVP-I. The amputation rate was higher in the conventional treatment group versus the shellac group (60.0% versus 46.2%, respectively), although this difference was not statistically significant.
  
  
  CONCLUSIONS
  Shellac is a natural solution that may be used to embalm gangrenous tissue in selected diabetic patients. More studies are needed to assess the long-term outcomes of this technique.
authors: Mohammed Hussein Al-Amoudi Chair for Diabetic Foot Research, King Abdulaziz University, Jeddah, Saudi Arabia. haaz59@yahoo.com
authors: Hasan
authors: H
authors: Alzahrani
authors: Yhya
authors: Y
authors: Bedir
authors: Abdulmonaim
authors: A
authors: Al-Hayani
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017719:Diabetic Foot / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D005734:Gangrene / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011206:Povidone-Iodine / Q000627:therapeutic use; D012116:Resins, Plant / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D012116:Resins, Plant; C003934:shellac; D011206:Povidone-Iodine
keywords: Shellac; amputation; diabetes mellitus; gangrene; ischaemia