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Michael D., a 60-year-old male with a complex medical history including type 2 diabetes mellitus, hypertension, and peripheral vascular disease (PVD), presented with a chronic, non-healing arterial ulcer located on the dorsal aspect of his left foot. The ulcer had persisted despite multiple attempts with conventional wound dressings. Notably, the patient had a functional vascular stent placed in the affected limb.

Patient Profile

• Age: 60

• Medical History: Type 2 diabetes mellitus, hypertension, peripheral vascular disease

• Presenting Wound: Chronic arterial ulcer on the dorsal left foot

• Previous Treatment: Ineffective wound dressings

• Other Factors: Functional vascular stent in the left leg

Objective

To achieve complete healing of a refractory arterial ulcer through a multidisciplinary wound care approach, while addressing underlying vascular insufficiency and promoting long-term prevention of ulcer recurrence.

Treatment Protocol

1. Comprehensive Evaluation

• Full clinical and wound history

• Physical examination of the lower extremities

• Ankle-Brachial Index (ABI) to assess arterial flow

• Evaluation for venous stasis and skin changes

2. Vascular Imaging and Diagnostics

• Doppler ultrasound and venous reflux studies

• Noninvasive vascular testing to exclude DVT, infection, and confirm adequate perfusion via stent

3. Skin and Infection Management

• Treatment of cellulitis, if present

• Maintenance of skin barrier with moisturizers to prevent breakdown

4. Nutritional and Lifestyle Interventions

• Smoking cessation counseling

• Customized dietary modifications for cardiovascular and diabetic health

• Patient education on proper wound care and general foot hygiene

5. Ulcer Management

• Routine debridement of necrotic tissue

• Use of moist wound healing principles

• Control of bacterial bioburden

6. Edema Reduction

• Leg elevation protocols

• Compression therapy when vascular clearance permitted

• Lymphedema management in the presence of phlebolymphedema

7. Advanced Wound Therapies

• UltraMist Therapy: Delivered 1–2 times weekly to support granulation tissue and healing

• Amniotic Tissue Grafts: Applied for regenerative support, protected by adaptic non-adherent dressings and moisture-retentive layers

8. Prevention and Maintenance Plan

• Long-term use of compression stockings

• Offloading strategies to minimize pressure

• Scheduled follow-ups for wound monitoring and diabetes control

Results

• Initial Response: Notable signs of healing observed at the first dressing change

• At 5 Weeks: Marked reduction in wound size and improved tissue quality

• At 14 Weeks: Complete wound closure achieved, with no signs of infection or recurrence

Conclusion

This case illustrates the successful healing of a chronic arterial ulcer in a high-risk patient with diabetes, hypertension, and peripheral vascular disease. The integrative treatment strategy—combining wound debridement, vascular evaluation, advanced therapies, and lifestyle optimization—resulted in full healing within 14 weeks. Early improvements and ultimate closure emphasize the value of a multidisciplinary, patient-centered approach in managing complex arterial ulcers. This case supports the effectiveness of advanced wound care protocols in improving outcomes for medically complex patients.