Topical phenytoin and wound healing

NewsBot · Sep 18, 2007

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The clinical effect of topical phenytoin on wound healing: a systematic review.
Shaw J, Hughes CM, Lagan KM, Bell PM.
Br J Dermatol. 2007 Sep 13; [Epub ahead of print]

Background 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.

Objectives Systematically to identify, summarize and critically appraise the clinical evidence available on the effects of topical phenytoin on wound healing.

Methods Systematic searches were carried out in PubMed (1963-2005), Medline (1966-2005) and Cinahl (1982-2005) for the years listed and in the Cochrane Library and the University of York NHS Centre for Reviews and Dissemination. The search terms used the following key words alone and in combination: phenytoin, wounds and injuries, wound healing, and wound care. Secondary hand searching was also carried out using relevant journal articles and reference lists, historical books, conference proceedings and theses in the area of wound healing. Papers were included if they described randomized controlled trials (RCTs) on humans and if the primary aim was wound closure, with a secondary aim of measuring wound healing over time. The methodological quality of the papers in this systematic review was assessed using the van Tulder method and in addition best-evidence synthesis was carried out. The magnitude of the effect of phenytoin therapy in the studies included in the systematic review was investigated in four of the 14 trials.

Results Fourteen RCTs were included in the systematic review. Two papers were of high and 12 papers of low to moderate methodological quality. Most papers failed to describe randomization, treatment allocation and blinding techniques adequately. There was moderate evidence presented to support the use of phenytoin for the treatment of leg ulcers, leprosy wounds, chronic wounds and diabetic foot ulcers. There was a positive percentage treatment effect in favour of the phenytoin-treated group in one study investigating diabetic foot wounds and one study on chronic wounds. There was limited evidence for the use of phenytoin on burns and war wounds.

Conclusions Overall it would appear that studies investigating the effect of topical phenytoin on wound healing are of moderate methodological quality, and these suggest that there may be a positive effect on wound healing in a variety of wounds.
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NewsBot · Jan 11, 2009

The impact of topical phenytoin on recalcitrant neuropathic diabetic foot ulceration.
El-Nahas M, Gawish H, Tarshoby M, State O.
J Wound Care. 2008 Dec 19;18(1):33-37

Objective: To study the impact of topical phenytoin on the healing of recalcitrant neuropathic diabetic foot ulcers in patients with no clinical evidence of ischaemia or infection, and to evaluate its antibacterial effect.

Method: Thirty-two patients were enrolled into the study. Topical phenytoin in the form of 2% aerosol powder was applied once daily in addition to the patients usual treatment (weekly sharp debridement, offloading and use of a gauze dressing) for eight weeks. The primary outcome was change in ulcer area over time, measured by grid tracing. Secondary outcomes were the ability of topical phenytoin to eradicate bacterial isolates, and the occurrence of adverse events.

Results: Topical phenytoin significantly improved healing of recalcitrant neuropathic diabetic foot ulcers. Baseline wound area was 319.3 + 340.4mm2, reducing to 286.1 + 341.1mm2 and 269.1 + 341.2mm2 after four and eight weeks respectively. However, the overall reduction in ulcer size was only 18.3% + 27.5% and 25.7% + 38.6 % respectively. Topical phenytoin therapy over eight weeks did not eradicate any of the bacterial wound isolates (Staphylococcus spp., Proteus spp. or Pseudomonas spp.). Of the 32 patients evaluated, only eight (25%) achieved more than 50% reduction in ulcer size after eight weeks of treatment.

Conclusion: Topical phenytoin can enhance wound healing in recalcitrant neuropathic diabetic foot ulcers, although only one-quarter of patients achieved more than 50% reduction in ulcer size after eight weeks of therapy. Further research is needed to characterise those patients who will satisfactorily respond to such therapy
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NewsBot · Apr 12, 2011

The effect of topical phenytoin on healing in diabetic foot ulcers: a randomized controlled trial
J. Shaw et al
Diabetic Medicine (in press)

Aim: The aim of the study was to evaluate the effect of topical phenytoin on healing in diabetic foot ulcers. A randomized, controlled, double-blind, clinical trial was conducted.

Methods: A phenytoin dressing and a control dressing were manufactured. Individuals who were ≥ 18 years of age with peripheral neuropathy, an ankle brachial pressure index > 0.5 and a diabetic foot ulcer ≥ 4 weeks’ duration were independently randomized to the phenytoin group (31 participants) or the control group (34 participants). Participants with renal disease, ankle brachial pressure index < 0.5, necrosis or osteomyelitis were excluded. Subjects received standard wound care and dressing application. Primary endpoint analysis (diabetic foot ulcer closed or not at 16 weeks) was calculated by survival analysis.

Results: Participants (n = 65, 52 with Type 2 diabetes) were treated for a maximum of 16 weeks. Sixty per cent of the diabetic foot ulcers closed overall (18 in the phenytoin group, 20 in the control group) with no statistically significant differences in complete healing or in diabetic foot ulcer area over time between the two groups. At 24-weeks follow-up, one diabetic foot ulcer had recurred.

Conclusions: There were no differences in diabetic foot ulcer closure rates or in diabetic foot ulcer area over time between the two groups. This study does not support the use of phenytoin in the treatment of diabetic foot ulcers.
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NewsBot · Jun 20, 2013

From Podiatry Today:
Can Phenytoin Help Heal Diabetic And Venous Ulcers?

NewsBot · Oct 16, 2013

Topical Phenytoin Application in Grade I and II Diabetic Foot Ulcers: A Prospective Study
Vijaya Patil, Rashmi Patil, P. L. Kariholu, L. S. Patil, Praveeen Shahapur
Journal of Clinical and Diagnostic Research [serial online] 2013 October [cited: 2013 Oct 15 ]; 7:2238-2240

Background: India is fast becoming world diabetes capital. Diabetic foot infections are major problems among innumerable complications associated with diabetes.

Material and Methods: A randomized control study was conducted to evaluate the effect of topical phenytoin on healing in diabetic foot ulcers. One hundred patients with grade I/ II diabetic foot ulcers were randomly divided into two equal groups. Patients subjected to topical phenytoin dressing were classified under study and those who underwent normal salinewound dressings were classified as control. Both the groups were compared in terms of discharge, slough, wound area reduction and duration of hospital stay.

Results: Discharge and slough from wound reduced significantly by day 14 in phenytoin group and within 21 days in control group. Mean duration of hospital stay in phenytoin group was 20 days, whereas in control group, it was 26 days. This difference was statistically significant (p value <0.005,df 1).

Conclusion: Hence, Phenytoin proved to be useful as a topical agent in promoting healing and in controlling infections in diabetic foot ulcers.
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NewsBot · Mar 29, 2014

Scientific production on the applicability of phenytoin in wound healing.
Firmino F, Almeida AM, Silva RD, Alves GD, Grandeiro DD, Penna LH.
Rev Esc Enferm USP. 2014 Feb;48(1):162-169.

Phenytoin is an anticonvulsant that has been used in wound healing. The objectives of this study were to describe how the scientific production presents the use ofphenytoinas a healing agent and to discuss its applicability in wounds. A literature review and hierarchy analysis of evidence-based practices was performed. Eighteen articles were analyzed that tested the intervention in wounds such as leprosy ulcers, leg ulcers, diabetic foot ulcers, pressure ulcers, trophic ulcers, war wounds, burns, preparation of recipient graft area, radiodermatitis and post-extraction of melanocytic nevi. Systemic use ofphenytoinin the treatment of fistulas and the hypothesis of topical use in the treatment of vitiligo were found. In conclusion, topical use ofphenytoinis scientifically evidenced. However robust research is needed that supports a protocol for the use ofphenytoinas another option of a healing agent in clinical practice.
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NewsBot · Jul 29, 2014

A comparison of efficacy of topical use of phenytoin and vaseline gauze dressing with vaseline gauze dressing alone in healing of diabetic foot ulcers
Anis Ahmed, Malik Irfan Ahmed
Jnl of Post Grad Med Vol 28, No 3 (2014)

Objective: To compare efficacy of topical use of Phenytoin and Vaseline Gauze dressing with Vaseline Gauze dressing alone in healing of diabetic foot ulcers.

Methodology: This randomized controlled trial was carried out in Surgical unit I of Benazir Bhutto Hospital from January to June 2013. Study included 60 diabetic patients with Wagner grade 1 & 2 ulcers on foot for more than 04 weeks with adequate control of diabetes. Patients with history of hepatic and renal diseases; on steroid use; or with impalpable foot arteries; were excluded. Thirty each were randomized to phenytoin and vaseline gauze dressing and vaseline gauze alone groups, respectively. At baseline and after 08 weeks, area of wound was measured using graph paper tracings and healing percentage was calculated.

Results: Mean age of the sample was 53.83±6.66 years. Thirty six (60%) were males. Twenty five (41.67%) patients had Wagner grade 1 and 35 (58.33%) had grade 2 foot ulcers. Age, gender distribution and severity of foot ulcers according to Wagner grades were similar between two groups. In phenytoin & Vaseline group, the mean baseline ulcer area decreased from 1310±489.2mm2 to 492.53±460.9 mm2 at 8-weeks. In vaseline alone group, the mean baseline ulcer area decreased from 1107.53±486.58 mm2 to 662.63±497.8 mm2. In phenytoin & vaseline group, the treatment was effective in 21 (70%) patients, whereas in vaseline alone group, the treatment was effective in 13 (43.3%) patients; p= 0.037.

Conclusion: Phenytoin and vaseline dressings were significantly more effective as compared to vaseline alone dressings.
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NewsBot · Feb 20, 2016

The efficacy of topical phenytoin in the healing of diabetic foot ulcers: a randomized double-blinded trial
Raghunath Prabhu, Chandni Ravi, Srinivas Pai, Gabriel Rodrigues
International Journal of Diabetes in Developing Countries; 17 February 2016

A randomized, double-blinded, controlled clinical trial was conducted 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. Patients over 18 years of age with type 2 diabetes and foot ulcers over 1 month duration were randomized to receive daily dressings containing either powder A (test powder containing topical phenytoin and metronidazole) or powder B (control powder containing topical metronidazole) for 14 days, following which, they underwent split-skin grafting. The percentage of decrease in the ulcer surface area, rate of granulation tissue formation, graft uptake, and percentage of negative culture sensitivity were compared between the two groups using the unpaired Student’s t test. A p value <0.05 was considered significant. Patient demographic and socioeconomic characteristics of the two groups were well matched. The primary outcome measured as the mean rate of decrease of size of the ulcer in patients of group A was 30.69 (?5.50 SD) and in group B was 24.43 (?5.96 SD) percent of total ulcer area (p < 0.0001). The mean rate of increase of granulation tissue in group A was 69 (?10.16 SD) percent of total ulcer area and in group B was 51.51 (?10.54 SD) percent of total ulcer area (p < 0.0001). Out of the 97 patients, 75 underwent grafting. The mean graft take up in group A was 76.57 % (?19.06 SD) and in group B was 66.48 % (?17.67 SD) (p = 0.0082). Forty-three percent of the study group was culture negative at day 14, of which 54.2 % belonged to group A as compared to 45.8 % in group B. Topical phenytoin is an effective, inexpensive, and easily available agent in the promotion of healing of diabetic foot ulcers.
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NewsBot · Mar 23, 2017

Analysis of outcome of diabetic foot ulcer following topical
phenytoin and betadine use: a comparative study
Arshad Azeez, N. S. Venkatesh, T. Shivakumar
Int Surg J. 2017 Apr;4(4):xxx-xxx

Background: Diabetic ulcer is the major cause of morbidity and excess hospital care cost for the patients with
diabetes and most frequent reason for hospitalization in patients. Diabetic foot ulcers precede almost 85% of
amputations in India. Though there are many modes for care of the wound, treating diabetic wounds are still an
enormous problem. Aim of the study was to analyse the outcome of topical phenytoin dressing as compared to
conventional wound dressing in diabetic ulcers and thus to know if phenytoin is a better and cheaper alternative
option in the management of diabetic ulcers
Methods: A sample of 90 patients were selected using purposive sampling technique. Of which 45 underwent topical
phenytoin dressings, remaining 45 underwent conventional wound care. Daily dressing was done for 14 days and then
was subjected to split skin grafting. The variables were compared based on rate of granulation tissue formation, graft
uptake & duration of hospital stay. The categorical variable was compared by chi square test and continuous variable
by student t-test. A p value <0.05 was considered significant.
Results: In Phenytoin group, mean rate of granulation tissue formation was 92.51%. Mean graft up-take was 92.98%
and mean hospital stay was 35.68 days. In Conventional group, mean rate of granulation formation was 83.31%. The
Mean graft up-take was only 78.09%, mean hospital stay was 47.31 days.
Conclusions: Topical phenytoin helps in faster healing of the diabetic ulcer and better graft up-take and reduces
hospital stay.
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NewsBot · Apr 2, 2017

A comparative analysis of the efficacy of topical phenytoin with
conventional wound dressing in healing of diabetic foot ulcers
Prasad S et al.
Int Surg J. 2017 Apr;4(4):1389-1393

Background: Foot ulcers secondary to diabetes mellitus are very difficult to treat. Various agents have been used
with varying success for their treatment. Recently phenytoin has been used in the treatment of these stubborn ulcers.
Therefore this study was conducted and compared for the efficacy of topical phenytoin with conventional wound
dressings in healing of diabetic foot ulcers.
Methods: This is a prospective study comprising of 50 patients which were divided into two groups. In group I
patients conventional betadine dressing was applied. In group II patients phenytoin was used for the dressing. Both
the groups were compared on various parameters like time required for healing, complications, grafting and the
results were statically evaluated.
Results: Increased rate of granulation tissue formation was seen in topical phenytoin group when compared to
conventional group. Better graft take up was seen in topical phenytoin group when compared to conventional group.
On contrasting the number of days required for healing, effect on bacterial load and side effects of topical phenytoin
dressing with conventional betadine dressing, the former yielded better results in all respects.
Conclusions: Topical phenytoin dressing
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NewsBot · Jul 4, 2017

A COMPARATIVE STUDY OF EFFICACY OF LOCAL INSULIN VERSUS TOPICAL PHENYTOIN IN DIABETIC FOOT ULCER
Sanjeev Rao M et al
017Month : JuneVolume : 4Issue : 51Page : 3145-3148

BACKGROUND
Diabetic foot ulcer is the common complication and it affects almost 15% of all diabetic patients. Majority of the ulcer can heal. Healing is better in neuropathic ulcer than neuroischaemic ulcer. In India, diabetic foot ulcer is common cause of nontraumatic amputation of limbs, which is preventable.

MATERIALS AND METHODS
It is an open labelled randomised prospective study conducted at Department of General Surgery, Konaseema Institute of Medical Sciences, Amalapuram. Total 90 patients divided randomly into three groups include this study as per exclusion and inclusion criteria. Group A were diabetic foot ulcer belongs to topical insulin dressing group. Group B belongs to topical phenytoin group and group C belongs to conventional wound care group.

RESULTS
In group A, size of the wound reduced from mean value 6.8 cm2 to 1.4 cm2; percentage change in the size of the wound was 79.4%. In group B, the size of the wound reduced from 5.9 cm2 to 2.4 cm2; percentage reduction in the size of the wound was 59.3%. In group C, the mean size of the wound was reduced from 7.1 cm2 to 4.2 cm2; percentage reduction was 40.8%. The depth of the wound also reduced in the entire three groups. Mean reduction in the depth of the wound in group A was 9 mm to 2 mm that is 77.7%. In group B, the percentage mean reduction was 69.0%, and in group C, it was 51.2%.

CONCLUSION
In present study, we have found that percentage change in the mean surface area of wound in insulin group is 79.4%. The percentage change in mean of wound surface area of wound in group B (phenytoin group) was 59.3%, which is less than insulin group. There was significant change in the depth of wound in both the group, but in insulin group, it is better than phenytoin group.
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NewsBot · Sep 22, 2017

The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study
Vijay Gunasekaran, Saravanakumar Subbaraj, Tirou Aroul
Int J Surg

Background: Diabetic foot infection constitutes up to 10 percent of diabetes-related hospital admissions and the prevalence of diabetes is 2.4% in rural and 12-17% in urban settings. The quest for better wound healing agents for diabetic ulcers is perhaps one of the oldest challenges for medical practice. One such agent that has been tried in wound healing is phenytoin. A common side effect of phenytoin (diphenylhydantoin) treatment for epilepsy is gingival hyperplasia. This stimulatory effect of phenytoin on connective tissue suggested a possibility for its use in wound healing.

Methods: 60 patients with diabetic foot ulcer admitted in General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India were randomly assigned into two groups, the study group consisting of 30 patients who were treated with phenytoin dressing and 30 patients into control group who were treated with conventional saline dressing. Both groups underwent initial debridement and were started on parenteral antibiotics according to wound swab culture and sensitivity. Study group were treated with phenytoin dressing and the wound was assessed based on the rate of ulcer size reduction, the rate of granulation tissue, duration of hospital stays and antibacterial property of phenytoin. Patients were assessed weekly up to 21 days.

Results: The rate of granulation tissue in phenytoin group was 90.36% which was statistically significant (p = 0.0011) as compared to control group which was 82.03%. Wound swab cultures repeated on day 21 revealed that there was 50% negative culture in phenytoin group when compared to control group of 24% which also was statistically significant. The mean hospital stay for the patient in phenytoin group was 29.2 days and in control group, it was 26.1 days. It was observed that surface area reduction in phenytoin group was 41.25cm2 to 18.38cm2 and in control group was 40.28cm2 to 20.23cm2 by the end of 21 days, but this was not statistically significant.

Conclusions: Phenytoin dressing is effective in increasing the rate of granulation tissue by virtue of its action on stimulating fibroblast proliferation and decreasing collagenase activity. It not only hastens granulation tissue but also decreases bacterial load as compared to conventional dressing by virtue of its intrinsic antibacterial activity and indirectly through their effects on anti-inflammatory cells and neovascularization. Phenytoin prepares the foot ulcer for early grafting thereby improving the overall outcome.
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NewsBot · Apr 20, 2019

The impact of topical phenytoin loaded nanostructured lipid carriers in diabetic foot ulceration.
Motawea A et al
Foot (Edinb). 2019 Mar 14;40:14-21

OBJECTIVE:
The aim of this study is to develop, and characterize nanostructured lipid carriers (NLCs) of phenytoin (PHT) in order to improve its entrapment efficiency and sustained release to improve the healing process.

METHODS:
Twenty-seven patients with neuropathic diabetic foot ulceration (DFU) were enrolled in this study. Patients were comparable regarding size, grading of ulcer and control of diabetes with no major deformity. All patients were managed by weekly sharp debridement if indicated and offloaded with cast shoes. They were equally divided into three groups: PHT-NLC-hydrogel (0.5%w/v), phenytoin hydrogel (0.5%w/v) and blank hydrogel groups. Changes in wound area were monitored over 2 months.

RESULTS:
Baseline wound area of PHT-NLC, PHT and blank hydrogels were 5.50 ± 3.66, 3.94 ± 1.86 and 5.36 ± 2.14 cm2, respectively. Ulcers treated with PHT-NLC hydrogel showed smaller wound area compared to control groups (ρ < 0.05). The overall reduction in ulcer size were 95.82 ± 2.22% for PHT-NLC-hydrogel in comparison to 47.10 ± 4.23% and -34.91 ± 28.33% for PHT and blank-hydrogel (ρ < 0.001), respectively.

CONCLUSION:
PHT-NLC hydrogel speeds up the healing process of the DFU without adverse effects when compared to the positive and negative control hydrogels. Moreover, the study can open a window for topical application of NLCs loaded with PHT in the treatment of numerous dermatological disorders that resist conventional treatment.

KEY MESSAGE:
The delivery of drug molecules and their localization into the skin is the main purpose of the topical dosage forms. In this manuscript, the impact of topical phenytoin loaded nanostructured lipid carrier in improving wound healing in patients with neuropathic diabetic foot ulceration was investigated. Phenytoin loaded nanostructured lipid carrier dressing was found to be more effective than phenytoin hydrogel at the same concentration in healing of neuropathic diabetic foot ulcer.
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NewsBot · Jul 24, 2019

A Prospective, Randomized, Controlled Study For Efficacy of Phenytoin Sodium Powder, Eusol Solution, Nanocrystalline Silver Gel in Diabetic Foot Ulcer
Chauhan Ajay et al
International Journal of Contemporary Surgery; Year : 2019, Volume : 7, Issue : 2

Background

Diabetic foot is one of the most significant and devastating complications of diabetes. Not all foot complications can be prevented, but it is possible to dramatically reduce their incidence through appropriate management and prevention. Various dressings are available that fulfils a number of functions like cosmesis, haemostasis, protection, support and absorption.

Objectives

To study and compare the efficacy of different topical agents like phenytoin sodium powder, eusol solution, nanocrystalline silver gel in patient with diabetic foot ulcer by recording the mean ulcer size pre-treatment, during the course of treatment (1 week, 2 week, 3 week and 4 week follow up) and post- treatment and mean percentage of the wound size healing after treatment.

Material & Method

This prospective study was conducted in the Department of General Surgery, Geetanjali Medical College & Hospital, affiliated to Geetanjali University from January 2017 to June 2018. 90 patients with diabetic foot ulcers without any other co-morbid conditions and ulcers belonging to Grade I & II as per Wagner diabetic foot ulcers classification were compared with the efficacy of different topical agents.

Results

Out of 90 patients, there was a highly significant reduction in the mean ulcer size after 2 week, 3 week and 4 week follow up in nanocrystalline silver gel group (p<0.05) as compared to the phenytoin sodium powder and eusol solution group and the formation of granulation tissue was higher in nanocrystalline silver gel group (90%) as compared to phenytoin sodium powder (80%) and eusol solution (73.33%).

Conclusion

Dressings done with nanocrystalline silver gel was found to be more efficacious than the other topical agents in patients with diabetic foot ulcers in terms of increased rate of wound healing, greater reduction in the mean ulcer size after treatment, absence of pain, swelling and type of discharge after treatment, greater incidence of formation of granulation tissue and less duration of antibiotic therapy and hospital stay.
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NewsBot · Jul 24, 2019

A STUDY ON TOPICAL USE OF PHENYTOIN SODIUM IN GRADE I AND GRADE II
DIABETIC FOOT ULCERS
Dr. K. Arul Kumaran et al
Volume-8 | Issue-4 | April-2019 | PRINT ISSN No 2277 -

Introduction: Diabetic foot ulcer is the most common complication of diabetes mellitus. Most of the patients with diabetes seek hospital
admission due to a diabetic foot ulcer. About 15% of diabetic patients have ended up with surgery following diabetic ulcer complications.
Objective: The objective of this study was carried out to assess the efcacy of topical application of phenytoin sodium powder on healing in
diabetic foot ulcer grade I and II.
Materials and Methods: The entire sample population 100 was divided into two equal groups that can be comparable, which is further divided
into 3 subgroups : moderate and poor control based on HBA1C value assigned regular saline dressing for the control group and phenytoin sodium
powder application for study group. Patients fullled the inclusion and exclusion criteria. Both the control and study group are compared for the
reduction in the surface area, granulating tissue formation, duration of hospital stay, wound swab for culture and sensitivity. effect of granulation
tissue formation based on HBA1C value and graft uptake to assess the healing process.
Results: The wound healing was assessed by the formation of granulation tissue, decrease in surface area, wound swab for culture and sensitivity,
duration of hospital stay and graft uptake post surgery. At the end of 14 days, the presence of healthy granulation tissue were markedly noted in 90%
of study group with phenytoin, and it was present only in 10% of control group. Moreover, also wound reduction was 66% in the study group, and
44% in the control group. Graft uptake in study group post surgery was 95.3% superior compared to the control group which was 66.6%. Mean
duration of time in the hospital is also signicantly reduced in phenytoin group which was 21 days compared to control group which was 40days.
Conclusion: On this study and literature review, we conclude phenytoin sodium powder topical application on diabetic foot ulcer promotes early
wound healing.
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NewsBot · Nov 21, 2022

The Efficacy of Local Insulin Versus Topical Phenytoin or Normal Saline in Diabetic Foot Ulcer Management: A Prospective Comparative Study
Jamuna Nagaraj, Venkatesh Subbiah
Cureus. 2022 Oct 19;14(10)

Introduction During an individual's lifetime, around 15% to 25% of patients with diabetes mellitus develop foot ulcers, and about 1% of patients end up with an amputation. For the past two decades, we have treated diabetic foot ulcers with a variety of methods including cleansing and dressing after debridement of the lesion, where the dressing is applied using local insulin, topical phenytoin, normal saline dressing, etc. We conducted the present study to compare the efficacy of diabetic foot ulcer management between local injectable insulin, topical phenytoin, and normal saline among diabetic patients. Methodology We conducted a prospective study of 60 patients with diabetic foot ulcers who sought outpatient care at the Department of General Surgery, in a tertiary care hospital in Perambalur, from September 2021 to August 2022. We included all patients who provided informed written consent and had ulcers ranging from grade 1-2. We excluded patients with foot ulcers caused by other etiologies such as osteomyelitis and renal failure. We divided the selected study participants into three groups using the number lot method (randomization). Twenty study participants made up each group; there were three groups in total - groups 1, 2, and 3. Group 1 was treated with local insulin; group 2 with topical phenytoin; and group 3 with normal saline dressing. Before the start of the study, we measured the wound size and depth of the wound and followed up at seven days intervals for one month. The results were analyzed using SPSS, version 21 (IBM Corp., Armonk, NY). Results The mean age, duration of diabetes, and mean fasting blood sugar values of the study participants in the three groups were almost similar. The mean difference in wound size before and after treatment in the insulin, normal saline, and phenytoin groups was 4.98, 3.74, and 3.805 square centimeters, respectively. This difference in mean among the above three groups was statistically significant (P < 0.001). The mean difference in wound depth before and after treatment in the insulin, normal saline, and phenytoin groups was 47.005, 4.945, and 4.820 square centimeters, respectively. This difference in mean among the above three groups was statistically significant (P < 0.001). Thus, wound healing was better in the local insulin group than in the other two groups, with statistical significance. The mean number of days taken for wound healing in the insulin, normal saline, and phenytoin groups was 20, 26, and 23 days, respectively. This difference in mean among the above three groups was statistically significant (P < 0.001). Conclusion The current study, which lasted a year in a tertiary care hospital, found that local injectable insulin heals diabetic foot ulcers more rapidly than local topical phenytoin, which is superior to the standard treatment of using normal saline.
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