Anstead G M, Hart L M, Sunahara J F, Liter M E
Department of Internal Medicine, Veterans Affairs (VA) Medical Center, Lexington, KY, USA.
Ann Pharmacother. 1996 Jul-Aug;30(7-8):768-75. doi: 10.1177/106002809603000712.
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.
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 with 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 was apparent. After 54 days of treatment, nearly all the sinus tracts were healed. Four months after treatment with topical phenytoin had facilitated the healing of the wounds, even though the patient's multiple underlying medical problems had not resolved.
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.
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 would healing and deserves further investigation.
描述一例IV级巨大压疮患者，其对局部应用苯妥英钠治疗反应迅速，并回顾支持该疗法应用的文献。
一名55岁病态肥胖的白人男性（体重266千克），因肥胖低通气综合征继发呼吸衰竭和心力衰竭，在住院的前两周，其下背部和骶骨出现压疮。传统治疗方法未取得成功，到第79天时，伤口累及整个腰骶部区域和臀部，并有广泛的潜行性破坏和窦道形成。在应用局部苯妥英钠2天内，可见新鲜肉芽组织。经过54天的治疗，几乎所有窦道均愈合。在局部应用苯妥英钠促进伤口愈合4个月后，尽管患者的多种基础疾病尚未解决。
苯妥英钠已用于压疮、静脉淤滞性溃疡、糖尿病溃疡、创伤性伤口和烧伤的愈合。许多现有临床研究存在方法学缺陷，如统计分析不当、对照组不充分以及缺乏随机化和双盲。尽管如此，所有研究均报告伤口愈合得到改善，且不良反应不明显。苯妥英钠可能通过多种机制促进伤口愈合，包括刺激成纤维细胞增殖、促进胶原蛋白沉积、糖皮质激素拮抗作用和抗菌活性。
苯妥英钠促进了对传统治疗无反应的巨大坏死性软组织伤口的愈合。该疑难病例的临床成功以及文献中的其他报道表明，苯妥英钠在伤口愈合方面有效，值得进一步研究。
