Kronik Diyabetik Ayak Ülserinde İntralezyonel İnsan Epidermal Büyüme Faktörünün Yara İyileşmesine Etkisi: Hasta Sonuçlarının Retrospektif Analizi

Abstract

Objective: Epidermal growth factor (EGF) plays an important role in wound healing. But, bioavailability of EGF is impaired in chronic diabetic foot ulcer (CDFU) due to increased protease activity. The study's objective was to evaluate the effect of intralesional human-EGF (h-EGF) on wound healing in patients with CDFU. Material and Methods: Twenty-eight patients with CDFU were included to study. 75 µg intralesional h-EGF thrice a week for 5 weeks were used to accelerate wound healing. Ulcer size was calculated by simple planimetric measurement. Specimens for culture were taken from all patients. Granulation response were evaluated with healing grade (HG) [HG-0 → no response, HG-I → minimal response, HG-II → partial response, HG-III → complete response] and complete wound closure. Pre- and post-treatment ulcers size were recorded to asses treatment outcome. Results: New granulation tissue over the wound (HG I-III) was present in 26 (92.8%) patients at the end of treatment. Complete wound healing (HG III) was achieved in 10 (35.7%) patients, complete wound closure was seen in 3 (10.7%) patients. Pre and post-treatment mean ulcers size were 23.9±18.5 and 6.5±4.8 cm2 (p=0.001). The most frequent adverse events of h-EGF were tremor (32.1%). Total of 47 causative bacterias (14 different types of bacteria) were isolated from 23 (87.2%) patients, whereas cultures were sterile in 5 (17.8%) of the patients. Primarily, Escherichia coli, Proteus mirabilis, Acinetobacter baumannii, Pseudomonas aeruginosa species were seen in rate of 19.1%, 17%, 12.7%, 10.6% respectively. Conclusion: Intralesional h-EGF is effective in the treatment of CDFU, has no serious side-effect and accelerates wound healing.