Aim of the study: To study the effect of topical phenytoin in healing of grade I and II diabetic foot ulcers. Background: Diabetic foot ulcers entail a lot of financial burden both to the patients and also to the treating hospitals. These are estimated to affect 15% of all diabetic individuals during their lifetime. These precede almost 85% of amputations. In India, prevalence of diabetic foot ulcer in clinical population is 3.61%. Increase in the prevalence of foot complications in India is attributed to socio-cultural practices such as bare foot walking, religious practices like walking on fire, use of improper foot wear and lack of knowledge regarding foot care. The three etiological mechanisms involved in formation of diabetic foot ulcer are-ischemia, neuropathy and infection.Phenytoin has been used by some workers and the possible mechanisms of its action in ulcer healing have been described as-increase in the proliferation of fibroblasts, increase in the deposition of collagen, neovascularisation, enhanced granulation tissue formation, decrease in the action of collagenase, decrease in bacterial contamination by removing Staphylococcus aureus, Escherichia coli, Klebsiella species, and Pseudomonas from the wound. Material and methods: A total of one hundred patients (66 males and 34 females) were enrolled in the study half of which were dressed with crushed phenytoin tablet powder (Group 1) and the remaining half was dressed with normal saline (Group 2). Statistical analysis was done using using the SPSS version 22 for Windows, Inc Chicago II.Descriptive statistics was used to find the mean± standard deviation.Mann Whitney test was done to find the difference between the various variables in the two groups. Results: Phenytoin was found to help in early healing of diabetic foot ulcers with the mean epithelisation time was found to be significantly lower in the phenytoin group. Conclusion: Topical phenytoin enhances healing of diabetic foot ulcers and is a cheap and effective modality of treating these patients.
Negative topical pressure, the general category to which the trademarked VAC therapy belongs, is not a new concept in wound therapy. It is also called subatmospheric pressure therapy, vacuum sealing, vacuum-assisted closure therapy, vacuum pack therapy, and sealing aspirative therapy. The VAC therapy system is trademarked by Kinetic Concepts, Inc., or KCI. It was first reported in 1997. The aim of the procedure is to use negative pressure to create suction, which drains the wound of exudate (i.e., fluid, cells, and cellular waste that has escaped from blood vessels and seeped into tissue) and influences the shape and growth of the surface tissues in a way that helps healing. Negative-pressure therapy for the closure of wounds accelerates secondary wound healing. High cost is still a hindrance in its use in developing nations. Many modifications were tried, but their efficacy is yet to be proved. In reality, this method is quite cost effective. It is only the lack of understanding and adequate setup which makes this method hard to use. The main objective of this paper is to focus on the cost effectiveness of VAC and its modifications. We want to emphasize the importance of homemade NPT and the use of simple suction devices.
Wound dehiscence is a postoperative complication encountered following abdominal surgery. A prospective randomized study was conducted to compare the incidence of wound dehiscence with a delayed absorbable and a nonabsorbable suture material in the mass closure of vertical laparotomy wounds. In one group, 100 patients were analyzed after closure with Prolene®, and in another group, 100 patients were analyzed after closure with Vicryl®. The incision was closed by continuous far and near suture technique using polypropylene (Prolene) suture in one group and a synthetic delayed absorbable polyglactin 910 (Vicryl) suture in the other group. There was significant difference in the incidence of wound dehiscence between the two groups: 6 % with Prolene and 17 % with Vicryl, (χ 2 05.944, 1 DF, P value00.0148). The overall incidence of wound dehiscence was 11.5 % in this study. The incidence of wound dehiscence in both the study groups was higher than expected as compared to previous literature. There was a significant difference between the two suture materials. In our study, Prolene is a better suture material for closure of vertical laparotomy wounds.
Introduction:The stimulatory effect of phenytoin on connective tissue suggested possibility for its use in wound healing. Oral phenytoin was first introduced as an antiseizure medication in 1937. Over 60 years investigators have shown an interest in how topical phenytoin may be used to promote wound healing in a variety of chronic wounds. Materials and Methods: A sample of 40 patients with diabetic ulcers was selected using purposive sampling technique. The patients were divided into two groups: Group A (Phenytoin group) (n=20) and Group B (conventional group) (n=20). In Group A, the patient's dressing were done using phenytoin and in Group B, with povidine. The patients were followed up on a daily basis for 9 days in both study and control groups. Wound culture was obtained at the start of the treatment and on the 7 th day of treatment. Then the patients were subjected to split thickness skin grafting on 10 th day. The follow up of the patients were done at one month after discharge in outpatient department for post skin grafting complications. Result: The mean duration of hospital stay in phenytoin group was 21.35±4.71 (SD) days and that in the conventional group was 27.3±6.48 (SD) days. One month follow up complications in conventional group were more as compared to phenytoin group. Conclusion: Topical phenytoin dressing helps in better granulation tissue formation and better graft take up than the conventional dressing. Hospital stay and post-operative complications were less in topical phenytoin dressing group as compared to conventional dressing group. Conflict of interest: Nil Source of funding: Nil
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