title: Intralesional application of epidermal growth factor in limb-threatening ischemic diabetic foot ulcers.
abstract: OBJECTIVE
  The intralesional injection of recombinant human epidermal growth factor (EGF-IL), a new therapy, has been claimed to prevent major amputations in advanced diabetic foot lesions. In this study, the efficacy of EGF-IL on advanced diabetic foot ulcers (DFU) was reviewed.
  
  
  METHODS
  Intralesional 75 µg EGF application (Heberprot-P® 75, Heber Biotec, Havana, Cuba) to 12 diabetic foot lesions in 11 patients (8 males, 3 females; mean age: 62.2±10.6 years) was evaluated. Most of the patients had undergone revascularization and received hyperbaric oxygen therapy (HBOT) and negative pressure wound therapy (NPWT), along with standard care, but failed to heal. After amputation was offered as the final option, EGF-IL was applied to evaluate its effects.
  
  
  RESULTS
  Two patients underwent amputation, while 10 lesions of the remaining 9 patients healed completely.
  
  
  CONCLUSIONS
  Our results prove that intralesional application of EGF can prevent amputations in advanced diabetic foot cases with an ischemic component. However, evidence in the literature supporting its use remains lacking, and its high cost presents an additional problem. Thus, we believe that intralesional application of EGF should be an option for ischemic wounds only after vascular evaluation (and intervention when possible), HBOT, NPWT, and standard care have proven insufficient.
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, İstanbul, Turkey. samilaktas@yahoo.com.
authors.forename: Şamil
authors.initials: Ş
authors.lastname: Aktaş
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of General Surgery, İstanbul, Turkey.
authors.forename: Selçuk
authors.initials: S
authors.lastname: Baktıroğlu
authors.affiliation: Van Region Hospital, Department of Underwater and Hyperbaric Medicine, Van, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Demir
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Ortopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Önder
authors.initials: Ö
authors.lastname: Kılıçoğlu
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Topalan
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Güven
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, İstanbul, Turkey.
authors.forename: Bengüsu
authors.initials: B
authors.lastname: Mirasoğlu
authors.affiliation: İstanbul University İstanbul Faculty of Medicine, Department of General Surgery, İstanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yanar
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000628:therapy*; D004815:Epidermal Growth Factor / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D014421:Turkey; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D011994:Recombinant Proteins; D004815:Epidermal Growth Factor