Authors: Andreas Pfützner, Thomas Segiet, Mina Hanna, Daiva Kalasauske, Daniela Sachsenheimer.
Background: Diabetic foot syndrome (DFS) is one of the most severe secondary complications of diabetes mellitus. It is currently treated with improvement and maintenance of good glycemic control, pain drugs, antibiotics, and drugs and surgical measures to improve the vascular blood flow into the legs. In late stages, foot amputation (in part or total) is the only means to safe the patient’s life.
Case Report: A 56-year-old woman with type 1 diabetes for more than 40 years, suffered from diabetic foot syndrome with complete closure of the arteria fibularis and a non-healing foot ulcer at the left leg. The need for lower ankle amputation was already determined. We tried to improve the vascular situation by means of a series of intravenous hyaluronidase infusions over a period of three weeks. An immediate improvement of the general condition was observed. The ulcer healed completely within 8 weeks, and a re-opening of the previously closed vessel as well as further additional collateral blood-flow into the left foot could be determined by means of an angiogram six months later.
Discussion: The observed beneficial impact of intravenous hyaluronidase treatment on atherosclerotic lesions can be explained by the molecular action of the enzyme on the glycocalix, the extracellular hyaluronan layer that separates the endothelial cells from the blood stream. Successful treatment of DFS with hyaluronidase infusions has been reported already 50 years ago but research on this topic ceased, when stents and other apparently more compelling vascular treatment methods were detected.
Conclusions: In a severe case of DFS, we were able to re-open a critical arterial vessel and improve the entire vascular blood flow by means of intravenous hyaluronidase infusions. Clinical studies are required to confirm the value of hyaluronidase infusions as treatment alternative to amputation for DFS.
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