A study to compare the effect of topical phenytoin dressing and conventional saline dressing in chronic non-healing ulcers


  • Manoj V. V. Department of General Surgery, Government T. D. Medical College, Alappuzha, Kerala, India
  • Biju Stephen Department of General Surgery, Government T. D. Medical College, Alappuzha, Kerala, India




Topical phenytoin dressing, Conventional saline dressing, Chronic ulcers, Non-healing ulcers, Diabetic ulcers, Venous ulcers


Background: Chronic non-healing ulcers; particularly diabetic and venous ulcers impose a major healthcare burden and affect quality of living. Efficacy of conventional strategies used for treatment of chronic non-healing ulcers is limited due to factors like microbial infection, necrotic tissues, tissue hypoxia, and other prevailing co-morbidities. The aim of the study was to compare efficiency of topical phenytoin-based dressings to conventional saline-based dressings for treatment of chronic non-healing wound ulcers.

Methods: A prospective observational study was conducted on 60 patients who were divided in two groups. First group received conventional saline dressing-based treatment and second received topical phenytoin dressing based treatment for chronic non-healing ulcers. Efficiency of the treatment strategy was determined by statistically comparing parameters like duration of hospital stay, nature of discharge, appearance of healthy granulation tissue, and pus culture evaluation upon admission and post one and two weeks of treatment.

Results: Diabetes and trauma were observed to be two major causes of chronic non-healing ulcers. No cases of venous impairment and osteomyelitis were observed in participating patients. Topical phenytoin dressing based treatment significantly reduced the duration of hospital stay and number of patients with serous discharge and aided in rapid formation of healthy granulation tissue in comparison to conventional saline based dressings. Topical phenytoin dressings also prevented microbial infection and colonization on chronic non-healing ulcers.

Conclusions: Topical phenytoin-based dressing was concluded to efficiently and rapidly heal chronic ulcers while preventing microbial infection in comparison to conventional saline-based dressings.


Sebastian KM, Lobato I, Hernandez I, Burgos AN, Gomez FMC, Lopez JL, et al. Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: Phase III study. BMC Fam Pract. 2014;15:211.

Han G, Ceilley R. Chronic Wound Healing: A Review of Current Management and Treatments. Adv Ther. 2017;34(3):599-610.

Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4(9):560-82.

Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013;1-9.

Anderson I. Aetiology, assessment and management of leg ulcers. Wound Essent. 2006;1:20‑36.

Rayner R, Carville K, Keaton J. Leg ulcers: atypical presentations and associated co-morbidities. Wound Pract Res. 2009;17(4):168-85.

Frykberg RG, Banks J. Management of Diabetic Foot Ulcers: A Review. Fed Pract. 2016;33(2):16-23.

Bowering CK. Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001;47:1007-16.

Musa HG, Ahmed ME. Associated risk factors and management of chronic diabetic foot ulcers exceeding 6 months' duration. Diabet Foot Ankle. 2012;3:10.

Vasudevan B. Venous leg ulcers: pathophysiology and classification. Indian Dermatol Online J. 2014;5(3):366-70.

Hunt D. Diabetes: foot ulcers and amputations. BMJ Clin Evid. 2009;602.

Najarian SJ, Stolusky T, Gohdes DM. Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria. Diabetes Care. 1992;15(10):1386-9.

Prabhu R, Vijayakumar C, Bosco CAA, Balagurunathan K, Kalaiarasi R, Venkatesan K, et al. Efficacy of Homologous, Platelet-rich Plasma Dressing in Chronic Non-healing Ulcers: An Observational Study. Cureus. 2018;10(2):2145.

Iqbal A, Jan A, Wajid MA, Tariq S. Management of Chronic Non-healing Wounds by Hirudotherapy. World J Plast Surg. 2017;6(1):9-17.

Knighton DR, Ciresi KF, Fiegel VD, Austin LL, Butler EL. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF). Ann Surg. 1986;204(3):322-30.

16. Shaw J, Hughes CM, Lagan KM, Bell PM. The clinical effect of topical phenytoin on wound healing: a systematic review. Br J Dermatol. 2007;157(5):997-1004.

Inchingolo F, Vermesan D, Inchingolo AD. Bedsores successfully treated with topical phenytoin. Acta Biomed. 2017;88(1):45-8.

Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018;6(6):12583.

Suthar M, Gupta S, Bukhari S, Ponemone V. Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series. J Biomed Sci. 2017;24(1):16.

Widatalla AH, Mahadi SE, Shawer MA, Elsayem HA, Ahmed ME. Implementation of diabetic foot ulcer classification system for research purposes to predict lower extremity amputation. Int J Diabetes Dev Ctries. 2009;29(1):1-5.

Sen CK. Human wounds and its burden: an updated compendium of estimates. Adv Wound Care. 2019;8(2):39-48.

Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: A comprehensive overview. World J Diabetes. 2017;8(4):135-42.

Kerstein MD. The non-healing leg ulcer: peripheral vascular disease, chronic venous insufficiency, and ischemic vasculitis. Ostomy Wound Manage. 1996;42(10):19-35.

Hokkam E, Labban G, Shams M, Rifaat S, Mezaien M. The use of topical phenytoin for healing of chronic venous ulcerations. Int J Surg. 2011;9(4):335-8.

Patil V, Patil R, Kariholu PL, Patil LS, Shahapur P. Topical Phenytoin Application in Grade I and II Diabetic Foot Ulcers: A Prospective Study. J Clin Diagn Res. 2013;7(10):2238-40.

Hao XY, Li HL, Su H. Topical phenytoin for treating pressure ulcers. Cochrane Database Syst Rev. 2017;2(2):8251.

Bharathi MP, Chapa UK, Chittoria RK. Role of phenytoin in diabetic foot ulcers. J Cutan Aesthet Surg. 2020;13(3):222-5.






Original Research Articles