Drug therapy of diabetic neuropathic foot ulcers: transvenous retrograde perfusion versus systemic regimen

Concerning the resistance of diabetic neuropathic plantar ulcers (DNPU) against systemically applied drugs, the "Retrograde Venous Perfusion" (RVP) was introduced by C. Ferreira in 1988. An isotonic saline solution containing gentamycin, buflomedil, dexamethasone, heparin and lignocain is injected into a dorsal foot vein under arterial occlusion of the lower leg. In the present study RVP treatment (1/90-12/90) was done in 20 patients with DNPU and the results were compared to a control group (CG) treated with systemic i.v. infusions (n = 20). After 10 days of treatment ulcers were closed in 6 vs. 0 (CG) patients, size diminuted in 10 vs. 3. Non responders were not observed under RVP in contrast to CG (7/20 cases). In 4 of 5 RVP patients with secondary osteomyelitis, yet in none of 7 CG cases some restoration of osteolytic lesions was seen. Rate of toe amputation dropped from 20% (CG) to 0%, mean time of hospitalization was cut by 7 days in the RVP group. Planimetry of the ulcered areas confirmed remarkable diminution in the RVP group. Considering the striking differences between either regimen, RVP can be recommended for treatment of DNPU especially when complicated by osteomyelitis.