CASE REPORT

 

Heberprot-P: use in diabetic foot

 

Tratamiento con Heberprot-P. Presentación de caso

 

 

Cecilio González, Julio Baldomero, Liubka María Pérez, Nancy Paredes, Aída R Hernández, Exavier Campos, Felipe Piñol

Hospital Provincial Clínico-Quirúrgico Docente Arnaldo Milián Castro Villa Clara, Cuba

 

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ABSTRACT

Here is described the treatment of a Venezuela female patient, who was diagnosed whith an ischemic diabetic foot, caused by a lasion on the top of the left foot. The metabolic parameters were stabilized after treatment. The infection of the lesion was controlled, and the wound was debrided, and further treated with 75 µg Heberprot-P until complete closure for 92 days, with 29 doses of the product.

Keywords: diabetic foot, Heberprot-P

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RESUMEN

Se describe el tratamiento a una paciente venezolana con diagnóstico de pie diabético isquémico causado por una lesión en la parte superior del pie izquierdo. Luego del tratamiento se logró la estabilización de los parámetros metabólicos de la paciente. Se controló la infección en el sitio de la lesión, y la herida se desbridóo y trató con Heberprot-P de 75 µg hasta el cierre total durante 29 dosis del producto tras 92 días.

Palabras clave: pie diabético, Heberprot-P

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VENEZUELAN FEMALE PATIENT

On February 12, 2009, a female patient accompanied by a niece arrived at the office for diabetic foot outpatient type III «Dr. Daniel Camejo Acosta», in Barquisimeto, Venezuela. The patient showed an injury on the dorsal part of the left foot. It was infected, very painful and spread to the space between the second and the third toes. A surgical cleaning was performed and the necrotic tissue was removed. An an atonic area remained with poor bleeding, typical of this type of injuries. She was hospitalized in Center for Integral Diagnosis «Labor Union House» in Barquisimeto, where a treatment with antibiotics was started. Appropriate complementary analyses were performed for the use of Heberprot- P, which started two days later.

PATIENT GENERAL DATA

Female patient MPP aged 67, with diabetes mellitus type 2 (27 years). She suffered from claudication. The injury had arised 15 days before the consultation, and it was 20 cm long. The levels of glycemia were as high as 186 mg/dL; hemoglobin: 11 g/dL; and showed leukocytosis, She was hospitalized in the above mentioned institution on February 14, 2009

HISTORY OF THE DISEASE

After wearing a new pair of shoes, the patient felt an injury on the foot dorsal part where a red area appeared.

Later it became black. The wound hurt the whole day, being more severe at night. Inflamatory signs gradually spread to interdigital spaces of the second and the third toes. The patient had fever at the moment of the consultation in the office for diabetic foot care where an insision was performed in the dorsal part of the foot to remove the necrotic area and the sloughed tissue. Antibiotic cream was applied and hospitalization was indicated to intiate the treatment with crystalline penicillin: 2 vials every 4 hours endovenous; metronidazole: 200 mg a bottle every 8 hours endovenous; trental: 300 mg each ampule, endovenous, every 12 hours: The following analyses were indicated: full hemogram, TGP, TGO, glycemia, creatinine, abdominal echogram , X rays of the thorax and the foot, Dupplex vacular ecogram of the lower limps and an almost plane wave was detected in the dorsalis pedis artery and that bilateral tibialis posterior, diffuse atheromatosis in the left popliteal artery. No atheromathose plaque was observed.

The diagnosis was ischemic diabetic foot grade II according to wagner scale

WOUND CHARACTERISTICS

The left foot showed important changes: hair loss, cold and pale skin , necrosis in the dorsum and perilesional inflammatory signs, spread to interdigital spaces. After debridament, the lesion showed minimum escaso bleeding, atonic bottom, heat and perilesional flush, abundant fetid secretion and necrotic tissue were perceived. The vascular examination,did not show posterior tibial pulse and filled bilateral pedial, with slow capilary.

SURGICAL TECHNIQUE AND HEALING

A debridament of the necrotic area was performed, the sphacelous tissue was removed as well as the exposed tendons, mainly from the second toe flexor. Bleeding was poor. Antibiotic ointment and sterile dressing were applied. The patient was hospitalized and then Heberprot-P was applied by alternate cures, three times a week, More than 30% granulation was achieved during the second week of the treatment. The patient was discharged on May 15, 2009.

RESULTS

Atfer a 92-day treatment with Heberprot-P, 100% granulation and healing of the injury was achieved. The lower limp was saved, despite the amputation criterium of other specialists. Glycemia levels went back to normal in the first week of treatment. The patient and her relatives felt satisfied. (Figure)

Received in July, 2010
Accepted for publication in August, 2010.

Cecilio González, Hospital Provincial Clínico-Quirúrgico Docente Arnaldo Milián Castro Villa Clara, Cuba E-mail: [e-mail]