SUPERIORITY OF REGIONAL RETROGRADE TRANSV ENOUS PERFUSIONS TO SYSTEMIC VENOUS INFUSIONS IN TREATMENT OF DIABETICS WITH NEUROPATHIC PLANTAR ULCERATION

Since systemic treatment of neuropathic plantar ulcers in diabetics (D NPU) has so far been rather ineffective, recent reports of successful management of DNPU by short-term retrograde transvenous leg perfusions (RVP) by South American angiologists encouraged us to apply this trea tment method in diabetics suffering from chronic DNPU. Hence, in a pro spective comparative clinical trial started in 1989 we have treated 45 male diabetics suffering from DNPU with the same daily doses of netil mycin, administered either in systemic venous infusions (SVI: n=21, th ree times/day) or in RVP (n = 24, once/day). After 10 consecutive days of treatment, ulcers had closed in 8 of the 24 patients treated with RVP, as against 3 of the 21 treated with SVI. Diminution of the ulcer area by > 30% including full debridement was achieved in 10/24 of the RVP cases (SVI: 4/21). During 6 months of follow-up, amputation of toe s or forefoot was necessary in only 1 patient in the RVP group, but in 4 in the SVI group. Partial restitution of osteolytic damage was obse rved in some cases after RVP. Our results show that regional netilmyci n therapy given by the RVP procedure is clearly superior to equal neti lmycin doses administered by SVI for the treatment of DNPU. RVP can be recommended in DNPU, particularly when the ulcers are complicated by infections.