Ömer Arda Çetinkaya1, Süleyman Utku Çelik2, Miraç Barış Erzincan1, Barış Hazır1, Hakan Uncu1

1Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
2Clinic of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey


Objective: This study aimed to investigate the efficacy of intralesional epidermal growth factor (EGF) in preventing the extremity from a major amputation and its effects on wound healing in chronic diabetic foot ulcers (DFUs).

Material and Methods: Thirty-three patients with DFUs were treated with intralesional EGF application between January 2013 and January 2017. The first endpoint was to determine the prevention rate of major amputation within 12 months following treatment. The second endpoints were the recovery of ulcer surface area with ≥ 50% granulation following two months and the healing of ulcer surface area with ≥ 75% granulation following six months after the first application of EGF.

Results: After three patients were excluded because of major side effects in the remaining 30 patients (48 DFUs), granulation rate of ≥ 50% was achieved in 24 (37 DFUs) patients, and not achieved in 6 (11 DFUs) patients eight weeks following the EGF application. A granulation rate of ≥ 75% was achieved in 21 (31 DFUs) patients after six months. At 12 months following the treatment, one major and seven minor amputations were performed, a total of 10 DFUs in five patients were not healed, and the DFUs in 17 patients completely recovered.

Conclusion: Intralesional EGF application has positive results in addition to good foot care in DFUs, and promising results can be obtained by protecting the extremity from amputation by using it in patients whose vascular intervention methods are not appropriate and have DFUs that do not heal with conventional wound care treatments.

Keywords: Amputation, diabetic foot ulcer, epidermal growth factor

Cite this article as: Çetinkaya ÖA, Çelik SU, Erzincan MB, Hazır B, Uncu H. Intralesional epidermal growth factor application is a potential therapeutic strategy to improve diabetic foot ulcer healing and prevent amputation. Turk J Surg 2020; 36 (1): 15-22.


Ethics Committee Approval

The study protocol was approved by a local ethics committee (03-153-18) and was conducted following the Declaration of Helsinki.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - Ö.A.Ç., H.U.; Design - Ö.A.Ç., S.U.Ç., H.U.; Supervision - Ö.A.Ç., S.U.Ç.; Resource - Ö.A.Ç., H.U.; Materials - Ö.A.Ç., S.U.Ç., M.B.E., B.H., H.U.; Data Collection and/or Processing - S.U.Ç., M.B.E., B.H.; Analysis and Interpretation - Ö.A.Ç., S.U.Ç.; Literature Review - M.B.E., B.H.; Writing Manuscript - Ö.A.Ç, S.U.C., M.B.E., B.H.; Critical Reviews - Ö.A.Ç, S.U.Ç.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.