To compare efficacy of recombinant human platelet derived growth factor dressing versus normal saliine dressing in wound reduction of chronic diabetic foot ulcer and the effect of hba1c level on healing of chronic diabetic foot ulcer

Objectives: To compare the efficacy of topically applied recombinant human platelet derived growth factor (rh-PDGF) in chronic diabetic foot ulcer with conventional normal saline dressing and to determine the effect of HbA1c level on healing of diabetic ulcer.
Method: The present study was a randomized controlled study conducted at Guru Nanak Dev hospital, Amritsar. Total of 60 patients with chronic diabetic foot ulcer were included and were divided in two groups of 30 each by randomization. The control group patients were treated with conventional dressing whereas the study group were treated with rh -PDGF dressing and observed over a period of 15 days for the efficacy of wound healing. Patients with pulseless limb, associated osteomyelitis, skin malignancy, cellulitis, diabetic ketoacidosis, pregnant or nursing mother, diabetic gangrene were excluded from the study. The initial wound area was recorded after sharp debridement. The area of target ulcer was measured and subjected to statistical analysis. The percentage of reduction of wound area was calculated. HbA1c levels were measured in these patients and the effect of blood sugar control upon healing of diabetic foot ulcer was seen.
Results: In our study it was observed that mean healed area was significantly higher in study group 9.77+2.72 cm as compared to control group 3.29+0.88 cm and mean area reduction of wound in percentage was significantly higher in study group 38.99+3.30% as compared to the control group 12.41+2.12%. The p value was less than 0.001 indicating that there was significant difference between wound healing of healing of rh-PDGF treated patients and patients treated by conventional methods. It was also observed that Hba1c level is a good predictor in assessing the response of host in healing of chronic ulcer. HbA1C level of > 12 was associated with decreased rate of healing of chronic diabetic foot ulcer.
Conclusions: The results of this study suggest that within the setting of a comprehensive wound management, rh-,rh-PDGF gel has an excellent efficacy and is to be used by patients. Higher the HbA1C level, it is associated with decreased neutrophil function, including leukocyte chemotaxis. Indeed, a greater elevation of blood glucose level PDGF gel increases the healing of lower extremity neuropathic ulcers in patients with diabetes. Moreover has been associated with a higher potential for suppressing inflammatory responses and decreasing host response to an infection and healing of chronic ulcer.