Topical Phenytoin: Role in diabetic ulcer care

Abstract

Foot complications are a major cause of hospitalization in patients with diabetes mellitus. The optimal topical therapy for diabetic foot ulcers remains ill-defined. Saline-moistened gauze has been the standard method; however, it has been difficult to continuously maintain a moist wound environment with these dressings. Phenytoin was introduced into therapy in 1937 for effective control of convulsive disorders with a common side effect being gingival hyperplasia. This stimulatory effect of phenytoin on connective tissue suggested possibility for its use in wound healing. The objective of this study was to assess the efficacy of topical phenytoin compared to conventional wound care in improving the healing process and to prove it as a relatively low cost and easy to use option in the management of diabetic ulcers. In this randomised control trial, the data from 50 patients with diabetic ulcers was collected, 25 patients underwent topical phenytoin dressing while remaining 25 underwent conventional wound care. Following parameters were calculated and compared for both groups: (1) Rate of granulation tissue formation (at the end of 14 days); (2) Graft survival and take up (fifth post-op day after split thickness skin grafting); and (3) Duration of hospital stay. Statistical analysis was done by SPSS ver. 20 and p-value of <0.05 was considered as significant. The following were observed: in study group, the mean rate of granulation tissue formation was 88.21%, mean graft take up was 93.78% of total ulcer surface area and mean hospital stay was 32.21 days. The control group showed, the mean rate of granulation tissue formation was 71.32%, the mean graft take up was 85.98% of total ulcer surface area and mean hospital stay was 38.76 days It was concluded that Topical phenytoin helps in faster healing with better graft take up and reduces hospital stay.