[Retrograde venous perfusion (RVP in ulcero-mutilating neuropathy]

The ulcero-mutilating neuropathy is defined by the triad of painless ulcers of the feet, sensitive polyneuropathy of the lower legs and osteolysis in the forefoot area. The condition mainly affects middle-aged men suffering from diabetes mellitus, liver diseases, alcoholism, obesity and constitutional foot deformities. Systemic venous infusions of appropriate antibiotics can hardly reach effective target tissue levels because of the damaged microcirculation. Thus we used retrograde venous perfusion (RVP) of several drugs into the injured leg during short time blockade of arterial blood supply and achieved better therapeutic effects. Applying the RVP route, a solution containing 200 mg netilmycin, 120 mg gentamycin, 50 mg buflomedil, 2500 IU heparin and 4 mg dexamethasone in 100 ml 0.9% saline was injected as bolus into a dorsal foot vein and the blood supply was blocked for 20 minutes. The RVP was carried out daily over a period of 7 to 10 days. We treated 7 patients suffering from a ulcero-mutilating neuropathy with the RVP. Over an observation period of up to four weeks, in one patient the plantar ulcers healed completely, while in the other six cases the RVP lead to a regression of inflammatory signs and a reduction of ulcer size of up to 50 per cent.