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

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

z Affects the eye, heart, kidney and feet

z Diabetic foot is the most common reason for

admission to hospital( the beginning of the end)
Diabetic foot

z Every 30 seconds a leg is amputated for diabetes

in the world
z Cost of foot ulcer in Europe is euro 7,700;
z Cost of amputation is euro 46,000
z 85% are preventable
z Diabetics 15x more at risk of amputation
z 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.

z 595 diabetic feet

z stratified into 4 risk groups
z Multiple factors determine the rate of
amputation in diabetic foot.
z 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 Optimize control of diabetes

z Multi-disciplinary approach
z Vascular investigations
z Bone scan
z ? MRI
z 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 life-
threatening conditions such as septicemia)

z No previous amputation

z 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

z The split skin grafts took in all cases and the

wounds healed within 8 weeks

z 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)

z Anti-malodorous
z Anti-inflammatory
z Analgesic
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

z Sherry E, Boeck H, Warnke PH : Topical application of a new

formulation of eucalyptus oil phytochemical clears methicillin-
resistant Staphylococcus aureus infection. Am J Infect Control.
2001 Oct;29(5):346

z 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.

z 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

z 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 30 with incurable squamous cell carcinoma of

the head and neck.
z Erosion caused fistulae, super-infection and pus
formation.
z Rinsed with KM 5mls bd plus oral antibiotics.
z All lost the foul smell by day 4.
z Anti-inflammatory, analgesic & anti-microbial
effects were noted.
z 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 DAY 72: healed fistula

of the left buccal mucosa with fistula.
Foul smell from suppuration.

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.