Role of phenytoin in healing of large abscess cavities

Abstract

The promotion of healing of large abscess cavities attained with topical phenytoin was evaluated in controlled studies of clinical and experimental wounds. In the clinical abscess cavities, phenytoin application in 20 patients compared with conventional treatment in 20 patients resulted in earlier separation of slough, decrease in oedema, control of pain and overall enhanced healing. The mean(s.d.) rate of reduction of wound area was 2.02(0.48) cm2/day in the phenytoin group versus 1.58(0.51) cm2/day in controls (P less than 0.05) on day 10, and 1.8(0.32) cm2/day versus 1.19(0.21) cm2/day (P less than 0.01) on day 20. The mean volume reduction rates at both the 10th and 20th day were 0.48(0.01) cm3/day for phenytoin versus 0.32(0.04) cm3/day for controls; (P less than 0.005). By day 20, 17 of the patients treated with phenytoin were rated as having healed completely, compared with only one of the controls. In a standardized guinea-pig model of the clinical abscess cavity, which included inoculation of the wound with Bacillus proteus and Klebsiella pneumoniae, an enhanced healing rate was also observed (at 7 days 0.40(0.05) cm2/day with phenytoin versus 0.21(0.08) cm2/day in controls; P less than 0.005). All eight of the animals treated with phenytoin healed by day 21, compared with one of the eight controls. Biopsies of wounds treated with phenytoin showed less inflammation, no necrosis, and enhanced neovascularization, collagen deposition and fibroblast proliferation compared to controls. Bacterial colonies also decreased more rapidly with the use of phenytoin.

Topical phenytoin dressing versus conventional dressing in diabetic ulcers

“…The antibacterial activity of phenytoin contributed to removal of Staphylococcus aureus, Escherichia coli, Klebsiella species, Pseudomonas. [6][7][8][9] Since some authors have reported use of phenytoin in healing of different ulcers including diabetic ulcer, it prompted us to conduct a study on the local use of phenytoin on diabetic ulcer healing.…”

Out Come of Topical Phenytoin in the Management of Diabetic Ulcers

“…Phenytoin has been used by many workers because of its positive effects in ulcer healing, such as increase in the proliferation of fibroblasts and deposition of collagen, neovascularization, enhanced granulation tissue formation, decrease in the action of collagenase and bacterial contamination [23][24][25][26][27] . The antibacterial activity of phenytoin contributed to removal of Staphylococcus aureus, Escherichia coli, Klebsiella species, Pseudomonas 9,16,20,28 . Since some authors have reported use of phenytoin in healing of different ulcers including diabetic foot ulcer, it prompted us to conduct a study on the local use of phenytoin on diabetic foot ulcer healing.…”

Efficiency of Topical Phenytoin on Healing in Diabetic Ulcer: A Randomized Control Trial

“…Diabetic foot ulcers are the major complication of diabetes mellitus; 15% of diabetic people suffer from foot ulcers. 5 The major increase in mortality is due to microvascular, macrovascular complications and poor wound healing. 6 Poor wound healing is due to prolonged inflammatory phase, which leads to poor granulation tissue formation.…”