The Effectiveness of a Medical Cocktail Therapy for Non-healing Refractory Ischemic Diabetic Foot Ulcers- Case Reports

Abstract

Abstract INTRODUCTION: Diabetic foot ulcers (DFU) are a serious complication of diabetes mellitus that can have significant medical and socioeconomic impact as well as increase in mortality rates. Healing of ischemic or neuro ischemic foot ulcers is most challenging as conventional therapies often fail to achieve adequate vascularity. Ulcers of the heel area can be very severe and strenuous to treat and can eventually end up in the amputation of the limb due to poor vascularity. So optimization of therapies to improve vascularity should be a major objective in successfully treating such cases. CASE PRESENTATION: Here we report two cases of chronic non-healing ischemic ulcers of the heel area of the foot. Patients approached us after the conventional medical treatments had failed to achieve healing. We treated them with a cocktail (Diabcare protocol) that we formulated using existing medications along with appropriate wound care and antibiotics. Diabcare protocol comprises plaque regression agents (statins), antiplatelet drugs (Aspirin), novel oral anticoagulant (Rivaroxaban) and vasoactive agents [PDE3 inhibitor (Cilostazol) and PDE5 inhibitor (Tadalafil)]. On Serial measurements, ulcers showed progressive healing and wound contraction. Vascularity improved significantly and fresh granulation appeared within days to weeks of initiation of therapy. Ulcers healed completely, with spontaneous epithelialization in the first case and after SSG in the second case, within a mean period of three months. CONCLUSION The ‘Diabcare protocol’ is found to be effective in healing difficult-to-heal ischemic foot ulcers where conventional treatment fails.