Phenytoin in wound healing

Gregory M Anstead, Lisa M. Hart, Janice Fong Sunahara, Melvin E. Liter

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

OBJECTIVE: To describe a patient with a massive Grade IV pressure ulcer that responded rapidly to treatment with topical phenytoin and to review the literature supporting the use of this therapy. CASE SUMMARY: A 55-year-old morbidly obese white man (266 kg), with respiratory failure secondary to obesity-hypoventilation syndrome and heart failure, developed pressure ulcers on his lower back and sacrum within the first 2 weeks of hospitalization. Traditional methods of treatment were unsuccessful, and by day 79, the wound involved the entire lumbosacral area and buttocks, and had extensive undermining and sinus tract formation. Within 2 days of applying topical phenytoin, fresh granulation tissue was apparent. After 54 days of treatment, nearly all the sinus tracts were healed. Four months after treatment with topical phenytoin was begun, the sacral wound was nearly healed and the lumbar wound was much 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 burns. Many of the existing clinical studies have methodologic flaws, such as inappropriate statistical analysis, inadequate control groups, and the absence of randomization and double-blinding. Nevertheless, all the studies have reported enhancement of wound healing, with insignificant adverse effects. Phenytoin may promote wound healing by a number of mechanisms, including stimulation of fibroblast proliferation, facilitation of collagen deposition, glucocorticoid antagonism, and antibacterial activity. CONCLUSIONS: Phenytoin promoted the healing of a massive, necrotizing soft tissue wound that was unresponsive to conventional treatment. Clinical success in this difficult case and the other reports in the literature suggest that phenytoin is effective in wound healing and deserves further investigation.

Original languageEnglish (US)
Pages (from-to)768-775
Number of pages8
JournalAnnals of Pharmacotherapy
Volume30
Issue number7-8
StatePublished - Jul 1996
Externally publishedYes

Fingerprint

Phenytoin
Wound Healing
Pressure Ulcer
Wounds and Injuries
Therapeutics
Obesity Hypoventilation Syndrome
Varicose Ulcer
Sacrum
Buttocks
Granulation Tissue
Random Allocation
Burns
Respiratory Insufficiency
Glucocorticoids
Hospitalization
Collagen
Heart Failure
Fibroblasts
Control Groups

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Anstead, G. M., Hart, L. M., Sunahara, J. F., & Liter, M. E. (1996). Phenytoin in wound healing. Annals of Pharmacotherapy, 30(7-8), 768-775.

Phenytoin in wound healing. / Anstead, Gregory M; Hart, Lisa M.; Sunahara, Janice Fong; Liter, Melvin E.

In: Annals of Pharmacotherapy, Vol. 30, No. 7-8, 07.1996, p. 768-775.

Research output: Contribution to journalArticle

Anstead, GM, Hart, LM, Sunahara, JF & Liter, ME 1996, 'Phenytoin in wound healing', Annals of Pharmacotherapy, vol. 30, no. 7-8, pp. 768-775.
Anstead GM, Hart LM, Sunahara JF, Liter ME. Phenytoin in wound healing. Annals of Pharmacotherapy. 1996 Jul;30(7-8):768-775.
Anstead, Gregory M ; Hart, Lisa M. ; Sunahara, Janice Fong ; Liter, Melvin E. / Phenytoin in wound healing. In: Annals of Pharmacotherapy. 1996 ; Vol. 30, No. 7-8. pp. 768-775.
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