Better Ways To Treat Diabetic Ulcers

BETTER WAYS TO TREAT: Diabetic Foot & Cancer Malodorous Ulcers Eugene Sherry Bond Univ., Australia Sureshan Sivananthan Keele Univ.,UK Patrick H Warnke Kiel Univ.,Germany

The Problem of Diabetes z

18 Million diabetics in the US; 250 million by 2025

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From 1980- 2004, the increase in US >2.5x

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Affects the eye, heart, kidney and feet

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Diabetic foot is the most common reason for admission to hospital( the beginning of the end)

Diabetic foot z z z z z z

Every 30 seconds a leg is amputated for diabetes in the world Cost of foot ulcer in Europe is euro 7,700; Cost of amputation is euro 46,000 85% are preventable Diabetics 15x more at risk of amputation Up to 70% of diabetics die within 5 years post amputation (BBC report 29 March, 2006).

PROGNOSTIC DETERMINANTS OF MINOR AND MAJOR AMPUTATION IN DIABETIC FOOT INFECTIONS Sureshan Sivananthan et al.

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595 diabetic feet stratified into 4 risk groups Multiple factors determine the rate of amputation in diabetic foot. Successful treatment and prevention of amputation require prompt detection of risk factors and aggressive surgical debridement and careful selection of amputation levels

The challenge

Current treatment z z z z z z

Optimize control of diabetes Multi-disciplinary approach Vascular investigations Bone scan ? MRI Amputation- midfoot/through ankle/below knee/above knee…

Inclusion criteria z

There is a threat to the LIMB but NOT yet the LIFE of the patient ( no immediate lifethreatening conditions such as septicemia)

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No previous amputation

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Consent

Treatment protocol-Step 1 z

Local debridement of the gangrenous area; repeated upto 5x to obtain a bleeding vital tissue residue

Step 2 z

Apply 5mls spray bd of an essential oil mix, Kielmix (www.fgb.com.au, Melbourne), is a mix of eucalyptus and tea-tree oils plus other ingredients* to the wound.

*lemongrass oil,clove oil, lemon oil,thyme oil

Step 3

Results

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The split skin grafts took in all cases and the wounds healed within 8 weeks

Standard amputations were avoided and limb length preserved.

Mechanism of action z

Anti-microbial effects ( staph.incl. MRSA, Strep.,E.coli, Candida,incl. multiresistent candida kruzei)

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Anti-malodorous Anti-inflammatory Analgesic

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Our papers z

Sherry E, Boeck H, Warnke PH : Percutaneous treatment of chronic MRSA osteomyelitis with a novel plant derived antiseptic. BMC Surg. 2001;1(1):1 Epub 2001 May16

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Sherry E, Boeck H, Warnke PH : Topical application of a new formulation of eucalyptus oil phytochemical clears methicillinresistant Staphylococcus aureus infection. Am J Infect Control. 2001 Oct;29(5):346

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Sherry E, Sivananthan S, Warnke PH, Eslick GD: Topical phytochemicals used to salvage the gangrenous lower limbs of type 1 diabetic patients. Diabetes Res Clin Pract. 2003 Oct; 62(1): 65-6.

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Warnke PH, Terheyden H, Acil Y, Springer IN, Sherry E, Reynolds M, Russo PAJ, Bredee J, Podschun R: Tumor smell reduction with antibacterial essential oils. Cancer. 2004 Feb 15;100(4):879-80

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Sherry E, Warnke PH: Successful use of an inhalational phytochemical to treat pulmonary tuberculosis: A case report. Phytomedicine. 2004 Feb;11(2-3):95-97

• Sherry E, Reynolds M, Sivananthan S, Mainawalala S, Warnke PH. Inhalational phytochemicals as possible treatment for pulmonary tuberculosis: two case reports. Am J Infect Control. 2004 Oct;32(6):369-70.

• Warnke PH, Sherry E, Russo PAJ, Sprengel M, Acil Y, Bredee JP, Schubert S, Springer IN: Antibacterial essential oils reduce tumour smell and inflammation in cancer patients. J Clin Oncol. 2005 Mar 1;23(7):1588-9 • Warnke PH, Sherry E, Russo PAJ, Açil Y, Jörg Wiltfang J, Sivananthan S, Sprengel M, Roldàn JC, Schubert S, Bredee JP, Springer ING: Antibacterial essential oils in malodorous cancer patients. Phytomedicine (2006), in press

Malodorous Cancer Ulcers z z z z z z

30 with incurable squamous cell carcinoma of the head and neck. Erosion caused fistulae, super-infection and pus formation. Rinsed with KM 5mls bd plus oral antibiotics. All lost the foul smell by day 4. Anti-inflammatory, analgesic & anti-microbial effects were noted. Improved quality of lie with the end of social isolation

Case 1 DAY 1: pus & smell

DAY 16: clean

75 yo male, inoperable squamous cell carcinoma of the left buccal mucosa with fistula. Foul smell from suppuration.

DAY 72: healed fistula

Case 3

DAY 1

DAY 21

76 yo male, huge inoperable SCC of the At 3 weeks, no pus, no erythema. pharynx, eroded to the side of his neck, Ulcer cleaner with fibrin layer at the enormous ulcer below his left ear. The base. foul smell resolved after 4 days of therapy.

Summary Thank you

We reports a potential technique to avoid amputations in diabetic gangrene AND A method to treat the foul smell of malodorous ulcers of cancer patients.