Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
The Effect of Intralesional Human Epidermal Growth Factor on Wound Healing in Chronic Diabetic Foot Ulcer: A Retrospective Analysis of Patient Results
Kronik Diyabetik Ayak Ülserinde İntralezyonel İnsan Epidermal Büyüme Faktörünün Yara İyileşmesine Etkisi: Hasta Sonuçlarının Retrospektif Analizi
Şule GÖKŞİNa, Mustafa Çağdaş ÇAYIRb
aDepartment of Dermatology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
bDepartment of Cardiovascular Surgery, Pamukkale University Faculty of Medicine, Denizli, Türkiye
Turkiye Klinikleri J Dermatol. 2022;32(3):157-69
doi: 10.5336/dermato.2022-90463
Article Language: EN
Full Text
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.

Keywords: Epidermal growth factor; diabetic foot; wound healing; adverse effect; culture
ÖZET
 Amaç: Epidermal büyüme faktörü [epidermal growth factor (EGF)], yara iyileşmesinde önemli bir rol oynar. Ancak artan proteaz aktivitesi nedeniyle kronik diyabetik ayak ülserinde (KDAÜ) EGF'nin biyoyararlanımı bozulur. Bu çalışmanın amacı, KDAÜ'lü hastalarda intralezyonel insan-EGF'nin [human-EGF (h-EGF)] yara iyileşmesi üzerindeki etkisini değerlendirmekti. Gereç ve Yöntemler: Çalışmaya KDAÜ'lü 28 hasta dâhil edildi. Yara iyileşmesini hızlandırmak için 5 hafta boyunca haftada 3 kez 75 µg intralezyonel h-EGF kullanıldı. Ülser boyutu basit planimetrik ölçüm yoluyla hesaplandı. Tüm hastalardan kültür için örnek alındı. Granülasyon yanıtı iyileşme derecesi (İD) ile değerlendirildi. [İD-0 → yanıt yok, İD-I → minimal yanıt, İDII → kısmi yanıt, İD-III → tam yanıt]. Tedavi sonucunu değerlendirmek için tedavi öncesi ve sonrası ülser boyutu kaydedildi. Bulgular: Tedavi sonunda 26 (%92,8) hastada yara üzerinde yeni granülasyon dokusu (İD I-III) mevcuttu. On (%35,7) hastada tam yara iyileşmesi (İD III), 3 (%10,7) hastada tam yara kapanması görüldü. Tedavi öncesi ve sonrası ortalama ülser boyutu 23,9±18,5 ve 6,5±4,8 cm2 idi (p=0,001). h-EGF'nin en sık görülen yan etkisi tremordu (%32,1). Yirmi üç (%87,2) hastadan toplam 47 etken bakteri (14 farklı bakteri türü) izole edilirken, 5 (%17,8) hastada kültürler sterildi. Öncelikle Escherichia coli, Proteus mirabilis, Acinetobacter baumannii, Pseudomonas aeruginosa türleri sırasıyla %19,1, %17, %12,7, %10,6 oranında görüldü. Sonuç: İntralezyonel h-EGF, KDAÜ tedavisinde etkilidir, ciddi bir yan etkisi yoktur ve yara iyileşmesini hızlandırır.

Anahtar Kelimeler: Epidermal büyüme faktörü; diyabetik ayak; yara iyileşmesi; istenmeyen etkiler; kültür
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