[Systemic infusion therapy versus retrograde intravenous perfusion: comparative results in patients with diabetic neuropathic plantar ulcer].

Concerning the resistance of diabetic neuropathic plantar ulcers (DNPU) against systemically applied drugs, the "Retrograde Venous Perfusion" (RVP) was introduced as a therapeutic alternative by C. P. Ferreira in 1988. An isotonic saline solution containing gentamycin, buflomedil, dexamethasone, heparin and lignocain is injected into a dorsal foot vein under arterial occlusion of the lower leg. In the present study RVP treatment was done in 20 patients with DNPU and the results were compared to a group treated with systemic intravenous infusions (SVI; n = 20). After 10 days of treatment, 8 out of 20 ulcers were closed (SVI: 4). In 9 ulcers (SVI: 4) size had diminuted by > 30%. Non responders were not observed under RVP in contrast to SVI (7/20 cases). In 4 of 5 patients with osteolytic bone lesions (SVI: 0/7), partial restoration was observed. Rate of toe amputation dropped to 0% (SVI: 20%). Considering the striking differences between either regimen, RVP can be recommended for treatment of DNPU especially when complicated by osteomyelitis.