Wound Care

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  • Clearly one of the main concerns of patients who have diabetes and of the physicians who treat these patients is wound care. Wounds that are not treated properly can lead to the loss of toes, feet, fingers and even limbs.
  • Numerous studies and case studies suggest the use of topical products that can consist of phenytoin, misoprostol, metronidazole and/or nifedipine. The data shows positive outcomes with these preparations with little to no adverse effects. The mechanisms of action of these preparations (how these work) are:
    • Phenytoin
      • Promotes granulation in a wound while providing antimicrobial effects and counteracting inflammation
    • Misoprostol
      • A synthetic prostaglandin that accelerates would healing
    • Metronidazole
      • Exerts an antimicrobial effect to assist in wound care
    • Nifedipine
      • Blocks the calcium influx into smooth muscles, thereby decreasing vascular tone, which in turn increases blood flow.
    • One of the main considerations when treating a wound is circulation. A patient with long standing diabetes often has hardening and narrowing of blood vessels in their lower extremities. When you combine this with other disease states, it is easy to see how this can lead to an ulcer. Circulation could be maintained by using a topical nifedipine preparation. In addition, the use of pentoxifylline can enhance vascular permeability, which increases circulation and increases penetration of medication and nutrients to the wound.
    • Believe it or not, proper nutrition has also been shown to affect the healing rate of a wound. In particular, deficiencies in zinc, vitamin C and other nutrients could play a role in these healing rates.
    • References
      1. Watkins PJ. ABC of diabetes. BMJ 2003; 216: 977-979.
      2. Gibbons GW. Lower extremity bypass in patients with diabetic foot ulcers. Surg Clin North Am 2003; 83(3): 659-669.
      3. Bennett SP, Griffiths BDF, Schor AM et al. Growth factors in the treatment of diabetic foot ulcers. Br J Surg 2003; 90(2): 133-146.
      4. Kincaid MR. Options in wound care. IJPC 2002; 6(2): 92-95.
      5. Talas G, Brown RA, McGrouther DA. Role of phenytoin in wound healing—a wound pharmacology perspective. Biochem Pharmacol 1999; 57(10): 1085-1094.
      6. Anstead GM, Hart LM, Sunahara JF et al. Phenytoin in wound healing. Ann Pharmacother 1996; 30(7-8): 768-775.
      7. Rhodes RS, Heyneman CA, Culbertson VL et al. Topical phenytoin treatment of stage II decubitus ulcers
      8. Glasnapp A. Basics of compounding for Raynaud’s disease. IJPC 2003; 7(4): 288-291.
      9. Meece J. Five compounds for treating diabetes-related conditions. IJPC 2003; 7(3): 170-174.
      10. Kincaid MR. Options in wound care. IJPC 2002; 6(2): 92-95.
      11. Todd G, Todd L. Case report: Nifedipine in Pluronic lecithin organogel improves circulation in the feet of a diabetic patient. RxTriad October 2001: 1.
      12. Blais LR, Blais B, Sundel RP. Case report: Nifedipine oral solution for the treatment of compromised peripheral vascular circulation in a pediatric patient. RxTriad July 2001: 1.
      13. Yarzab R, Graham D. Case report: Nifedipine in PLO 40 mg/mL for gangrene of the foot. RxTriad October 2000: 2.
      14. Torsiello MJ, Kopacki MH. Transdermal nifedipine for wound healing: Case reports. IJPC 2000; 4(5): 356-358.
      15. Jones M. Chronic neuropathic pain: Pharmacological interventions in the new millennium—a theory of efficacy. IJPC 2000; 4(1): 6-15.Israel A. Topical gel for the treatment of refractory leg ulcer. IJPC 2003; 7(3): 176-178.
      16. Rojas AI, Phillips TJ. Patients with chronic leg ulcers show diminished levels of vitamins A