Demonstration of the Effectiveness of Epidermal Growth Factor in Diabetic Foot Ulcers

Öz

Purpose: Diabetes affects more than 170 million people over the age of 20 worldwide. Diabetic foot ulcers (DFU) are one of the most common complications of diabetes. It negatively influence the patients' quality of life. Multidisciplinary treatment is required in the treatment of DFUs. In our study, we aimed to investigate the effectiveness of intralesional epidermal growth factor (EGF) in diabetic neuropathy foot ulcers. Materials and Methods: The study was conducted with 29 patients who applied to our clinic due to diabetic foot wounds between January 2014 and December 2020, who had no wound infection and osteomyelitis, who underwent EGF in accordance with the study criteria. In our study, EGF of 75µg/day 3 times a week was applied intralesionally to diabetic ulcers for 4-8 weeks. Results: A total of 29 patients were included in the study. 21 of the patients were male and 8 of them were female. The mean age was 59,82. One patient had signs of osteomyelitis. Additional disease was detected in 93,1% of the patients. The mean ulcer width of the patients was found to be 3,44 cm2. Conclusion: Three important results were obtained from the study. First; epidermal growth factor has been quite effective in the treatment of patients with DFU. The second important finding was to ensure the safe epithelialization of the standing ulcers without impairing the quality of life of the patients. Thirdly, after debridement, treatment with EGF was found to provide a significant improvement in wounds.

Anahtar Kelimeler

• Diabetes
• Epidermal Growth Factor
• Diabetic Foot Ulcer

Diyabetik Ayak Ülserlerinde Epidermal Büyüme Faktör Etkinliğinin Gösterilmesi

Öz

Amaç: Diyabet, tüm dünyada 20 yaşın üzerinde 170 milyondan fazla insanı etkilemektedir. Diyabetik ayak ülserleri (DAÜ) diyabetin en yaygın komplikasyonlarından birisidir. Hastaların yaşam kalitesini olumsuz etkilemektedir. DAÜ’lerinin tedavisinde multidisipliner tedavi gerekmektedir. Çalışmamızda diyabetik nöröpatili ayak ülserlerinde intralezyonel epidermal büyüme faktörü (EBF)’nin etkinliğini araştırılması amaçlanmıştır. Materyal ve Metot: Çalışma Ocak 2014-Aralık 2020 tarihleri arasında polikliniğimize diyabetik ayak yarası nedeniyle müracaat eden, yara enfeksiyonu ve osteomyeliti olmayan çalışma kriterlerine uygun EBF uygulanan 29 hasta ile yapıldı. Çalışmamızda tedavide, haftada 3 kez 75µg/gün EBF 4-8 hafta intralezyonel olarak diyabetik ülserlere uygulandı. Bulgular: Toplam 29 hasta çalışmaya alındı. Hastalardan 21 tanesi erkek, 8 tanesi kadındı. Yaş ortalaması 59,82 idi. Bir hastada osteomyelit bulgusu vardı. Çalışmaya dahil edilen hastaların %93,1’nde ek hastalık tespit edildi. Hastaların ülser genişlikleri ortalama 3,44 cm2 olarak bulundu. Sonuç: Çalışmadan üç önemli sonuç elde edilmiştir. Birincisi; epidermal büyüme faktörü, DAÜ olan hastalarda tedavide oldukça etkili olmuştur. İkincisi; hastaların yaşam kalitelerini bozmadan ayakta bulunan ülserlerin güvenli şekilde epitelize olmasını sağlamıştır. Üçüncüsü; yaraların debritman sonrası EBF ile tedavisi oldukça anlamlı bir düzelme sağlamaktadır.

Anahtar Kelimeler

• Diyabet
• Epidermal Büyüme Faktör
• Diyabetik Ayak Ülseri

Kaynakça

1. Meltem IT, Ilgın YS, Sinan M et al. Intralesional epidermal growth factor therapy for diabetic foot ulcers: an evaluation of 15 cases. Turk J Med Sci (2017) 47: 1500-1504
2. Pedro AL, Isis BY, Carmen VS et al. Medical practice confirms clinical trial results of the use of intralesional human recombinant epidermal growth factor in advanced diabetic foot ulcers, Adv Pharmacoepidem Drug Safety, 2 (2), 2013, 2-9
3. Şamil A, Selçuk B, Levent D at al. Intralesional application of epidermal growth factor in limb-threatening ischemic diabetic foot ulcers. Acta Orthop Traumatol Turc, 50(3): 2016, 277–283
4. Brem H, Sheehan P, Boulton AJ. Protocol for treatment of diabetic foot ulcers. Am J Surg. 2004 May;187(5A):1S-10S.
5. Hong JP, Jung HD, Kim YW. Recombinant human epidermal growth factor (EGF) to enhance healing for diabetic foot ulcers. Ann Plast Surg 2006; 56: 394-398.
6. Bulent ME, Benjamin AL, Ulas G et al. An assessment of intralesional epidermal growth factor for treating diabetic foot wounds. Journal of the American Podiatric Medical Association 2017, Vol 107, No 1.
7. Jorge BA, José FM, Calixto VP et al. Diabetic foot ulcers and epidermal growth factor: Revisiting the local delivery route for a successful outcome. Hindawi BioMed Research International Volume 2017, Article ID 2923759, 10 pages
8. Nabuurs-Franssen MH, Huijberts MSP, Nieuwenhuijzen AC et al. health-related quality of life of diabetic foot ulcer patients and their caregivers. Diabetologia (2005) 48: 1906–1910.

9. Aristides L, Garcia H, Ridelde JFS et al. Curative metatarsal bone surgery combined with intralesional administration of recombinant human epidermal growth factor in diabetic neuropathic ulceration of the forefoot: A prospective, open, uncontrolled, nonrandomized, observational study. Current Therapeutic Research 85 (2017) 2–7.
10. Rubio JA, Aragón-Sánchez J, Jiménez S et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot. Int J Low Extr Wound 2014; 13: 22-26.
11. Berlanga-Acosta J. Diabetic lower extremity wounds: the rationale for growth factors-based infiltration treatment. Int Wound J 2011; 8: 612-620.
12. Acosta JB, Savigne W, Valdez C et al. Epidermal growth factor intralesional infiltrations can prevent amputation in patients with advanced diabetic foot wounds. Int Wound J 2006; 3: 232-239.
13. Fernandez JI, Infante E, Valenzuela SC et al. Intralesional injections of Citoprot-P (recombinant human epidermal growth factor) in advanced diabetic foot ulcers with risk of amputation. Int Wound J 2007; 4: 333-43.