Intravenous infusion for the treatment of diabetic and ischaemic non-healing pedal ulcers.
Diabetic and ischaemic non-healing pedal ulcers have a tendency for chronicity and increased chances of infection, which may threaten the viability of the foot. Systemic administration of therapeutic agents may be insufficient in these cases. We have assessed the role of retrograde venous perfusion (RVP) for the treatment of nine diabetic and 10 ischaemic non-healing pedal ulcers. Agents used were soda bicarbonate, heparin, lignocaine, gentamicin and pentoxiphylline. Five of nine diabetic non-healing ulcers showed complete healing and the remaining four improved. The complete recovery in the cases of diabetic ulcer occurred in 10-24 days (mean 16 days), while ischaemic ulcers took 10-14 days for complete recovery (mean 13.6 days). There was a reduction of rest pain in all 10 patients with ischaemic disease; five patients showed complete healing of ulcers, and the other five improved significantly. In two patients, pre-gangrene changes were reversed. RVP is a useful adjunct to conservative or surgical treatment of non-healing pedal ulcers. Its main impact was in improving ischaemia and promoting healing.