The Effect of Topical and Oral Phenytoin on Increasing Wound Healing of Enterocutaneus Fistula in Wistar Rat
Keywords:Enterocutaneous fistula, Phenytoin, Wound healing
BACKGROUND: Enterocutaneous fistula is an abnormal connection between gastrointestinal tract with skin or wound and studies showed low numbers of spontaneous fistula closure (20–30%) despite proper wound treatment and nutrition with high morbidity and mortality rate in fistula repair operation. Phenytoin, commonly used as an anticonvulsant, has shown its effects on wound healing process such as promoting fibroblast activities, formation of granulation tissue, reduction of collagenase activities, increasing collagen production, and other connective tissue components, reducing bacterial colonization, and reducing wound exudate.
AIM: To assess the effects of phenytoin in enterocutaneous fistula wound healing in Wistar rats (Ratus norvegicus).
MATERIALS AND METHODS: This is an experimental study with randomized post-test only design on 20 Winstar rats. A 5 mm enterocutaneous fistula was made on the rat’s stomach and the rats were assigned randomly into three groups: K (control), P1 (10% phenytoin ointment), and P2 (0.03 mg/g oral phenytoin). The groups were terminated on day 7 and wound histological slides were made. The data were analyzed using SPSS software.
RESULTS: The delta diameter is highest in P1 group (mean + SD 0.928 + 0.078), followed by P2 (mean + SD 0.770 + 0.145), and control (mean + SD 0.411 + 0.120). There is a significant difference, p < 0.05 (0.000), between P1 and P2, indicating that oral phenytoin is more effective in collagen formation than topical phenytoin. There is no significant difference between P1 and P2, p < 0.05 (0.269), indicating that oral phenytoin is not more effective than topical phenytoin in granulation tissue in enterocutaneous fistula in Wistar rats.CONCLUSION: Administration of topical and oral phenytoin was effective in increasing granulation tissue thickness, increasing collagen amount in wound tissue, and reducing the diameter of enterocutaneous fistulas in Wistar rats compared with control on the seventh day.
Plum Analytics Artifact Widget Block
Sjamsuhidajat R, Dejong W. Buku Ajar Ilmu Bedah. 2nd ed. Jakarta: EGC; 2005. p. 636.
Enterocutaneous Fistula; 2013. Available from: http://www.emedicine.medscape.com/article/1372132-overview [Last accessed on 2013 Dec 15].
Parrish CR. Ostomies and fistula: A collaboration approach. Pract Gastroenterol. 2005;33:63-79.
Management of Enterocutaneous Fistula; 2001. Available from: http://www.downstatesurgery.org/files/cases/enterocutaneousfistula.pdf [Last accessed on 2013 Dec 15].
Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD, et al. Enteric fistulas: Principles of management. J Am Coll Surg. 2009;209(4):484-91. https://doi.org/10.1016/j.jamcollsurg.2009.05.025 PMid:19801322 DOI: https://doi.org/10.1016/j.jamcollsurg.2009.05.025
Lloyd DA, Gabe SM, Windsor AC. Nutrition and management of enterocutaneous fistula. Br J Surg. 2006;93(9):1045-55. https://doi.org/10.1002/bjs.5396 PMid:16804873 DOI: https://doi.org/10.1002/bjs.5396
Sheikh AR, Malik AM, Sheikh GA. Feasibility of early surgical intervention in postoperative entero-cutaneous fistulae. J Ayub Med Coll Abbottabad. 2010;22(4):37-40. PMid:22455257
Pratin C, Siriluck S. The management of patient with enterocutaneous fistula: A complex case study. Wound Pract Res. 2011;19:122-5.
Nordgren S, Fasth S, Hulten L. Anal fistulas in Crohn’s disease: Incidence and outcome of surgical treatment. Int J Colorectal Dis. 1992;7(4):214-8. https://doi.org/10.1007/BF00341224 PMid:1293243 DOI: https://doi.org/10.1007/BF00341224
Stewart DB Sr., Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR. Clinical practice guideline for the management of anal fissures. Dis Colon Rectum. 2017;60(1):7-14. https://doi.org/10.1097/DCR.0000000000000735 PMid:27926552 DOI: https://doi.org/10.1097/DCR.0000000000000735
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77-97. https://doi.org/10.1007/BF02050307 PMid:8416784 DOI: https://doi.org/10.1007/BF02050307
Jain BK, Vaibhaw K, Garg PK, Gupta S, Mohanty D. Comparison of a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula: A randomized, controlled pilot trial. J Korean Soc Coloproctol. 2012;28(2):78-82. https://doi.org/10.3393/jksc.2012.28.2.67 PMid:22606642 DOI: https://doi.org/10.3393/jksc.2012.28.2.67
Xu Y, Liang S, Tang W. Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula. Springerplus. 2016;5(1):1722. https://doi.org/10.1186/s40064-016-3406-8. PMid:27777858 DOI: https://doi.org/10.1186/s40064-016-3406-8
Gupta PJ, Heda PS, Shrirao SA, Kalaskar SS. Topical sucralfate treatment of anal fistulotomy wounds: A randomized placebo-controlled trial. Dis Colon Rectum. 2011;54(6):699-704. https://doi.org/10.1007/DCR.0b013e31820fcd89 PMid:21552054 DOI: https://doi.org/10.1007/DCR.0b013e31820fcd89
Motawea A, Abd El-Gawad AE, Borg T, Motawea M, Tarshoby M. The impact of topical phenytoin loaded nanostructured lipid carriers in diabetic foot ulceration. Foot (Edinb). 2019;40:14-21. https://doi.org/10.1016/j.foot.2019.03.007 PMid:30999080 DOI: https://doi.org/10.1016/j.foot.2019.03.007
Sayar H, Gergerlioglu N, Seringec N, Ozturk P, Bulbuloglu E, Karabay G. Comparison of efficacy of topical phenytoin with hypericin in second-degree burn wound healing: An experimental study in rats. Med Sci Monit Basic Res. 2014;20:36-46. https://doi.org/10.12659/MSMBR.890337 PMid:24694757 DOI: https://doi.org/10.12659/MSMBR.890337
Iqubal MK, Saleem S, Iqubal A, Chaudhuri A, Pottoo FH, Ali J, et al. Natural, synthetic and their combinatorial nanocarriers based drug delivery system in the treatment paradigm for wound healing via dermal targeting. Curr Pharm Des. 2020;26(36):4551-68. https://doi.org/10.2174/1381612826666200612164511 PMid:32532188 DOI: https://doi.org/10.2174/1381612826666200612164511
How to Cite
Copyright (c) 2022 Victor Kurniawan, Hardian Hardian, Ignatius Riwanto (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.