PHENYTOIN IN WOUND-HEALING

OBJECTIVE: TO describe a patient with a massive Grade IV pressure ulce r that responded rapidly to treatment with topical phenytoin and to re view the literature supporting the use of this therapy, CASE SUMMARY: A 55-year-old morbidly obese white man (266 kg), with respiratory fail ure secondary to obesity-hypoventilation syndrome and heart failure, d eveloped pressure ulcers on his lower back and sacrum within the first 2 weeks of hospitalization. Traditional methods of treatment were uns uccessful, and by day 79, the wound involved the entire lumbosacral ar ea and buttocks, and had extensive undermining and sinus tract formati on. Within 2 days of applying topical phenytoin, fresh granulation tis sue was apparent. After 54 days of treatment, nearly all the sinus tra cts were healed. Four months after treatment with topical phenytoin wa s begun, the sacral wound was nearly healed and the lumbar wound was m uch reduced in size. It was evident that phenytoin had facilitated the healing of the wounds, even though the patient's multiple underlying medical problems had not resolved. DISCUSSION: Phenytoin has been used in the healing of pressure sores, venous stasis and diabetic ulcers, traumatic wounds, and bums. Many of the existing clinical studies have methodologic flaws, such as inappropriate statistical analysis, inade quate control groups, and the absence of randomization and double-blin ding, Nevertheless, all the studies have reported enhancement of wound healing, with insignificant adverse effects. Phenytoin may promote wo und healing by a number of mechanisms, including stimulation of fibrob last proliferation, facilitation of collagen deposition, glucocorticoi d antagonism, and antibacterial activity. CONCLUSIONS: Phenytoin promo ted the healing of a massive, necrotizing soft tissue wound that was u nresponsive to conventional treatment, Clinical success in this diffic ult case and the other reports in the literature suggest that phenytoi n is effective in wound healing and deserves further investigation.