Topical phenytoin and wound healing in the diabetic foot

Abstract

Successful management of diabetic foot pathologies is a challenge due to the influence of peripheral neuropathy, peripheral vascular disease, a susceptibility to infection and abnormal distribution of plantar pressures. The aim of the current research was to evaluate the effect of topical Phenytoin on healing in diabetic foot ulcers.

A Systematic Review was conducted to investigate the treatment effect of Phenytoin on a variety of wounds including diabetic foot ulcers. This appeared to be positive overall. The review also highlighted the many challenges associated with the design of wound healing trials.

A review on wound measurement techniques and a clinical trial to determine the repeatability and validity of three methods of measurement was performed. Findings showed that there was no perfect method of wound measurement and that each method had advantages and disadvantages. The Elliptical method of measurement was chosen as the most appropriate method of measurement for use in the RCT as it was valid, repeatable, non-invasive for the participants and simple to use and analyse (p=0.017).

A Pilot Study was conducted to establish the safety and efficacy of the Phenytoin-containing dressing and the Control dressing. Participants were treated S4 weeks as described in the Study Protocol. Overall the safety and efficacy of the dressings were established and there were no adverse events. The study design was deemed to be feasible and was carried forward to the main RCT. The purpose of the main RCT was to determine the effect of topical PHT on healing in the diabetic foot. Participants (n=65) were independently randomised to the interventional (PHT) or Control group and treated :Sl 6 weeks. There was no statistically significant difference either in complete healing (p=0.96) or in percentage healing over time between the two groups (p=0.11). However, pain levels appeared to be reduced in the PHT-treated group.

Date of Award	2008
Original language	English
Supervisor	Katie Lagan (Supervisor) & Ciara Hughes (Supervisor)