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Ricardo M., a 48-year-old Hispanic male with a history of type II diabetes mellitus, presented with a severe, complex foot ulcer involving the dorso-lateral aspect of his left foot. The ulcer extended to the fifth digit and was complicated by gas gangrene reaching the left ankle. Due to Ricardo’s occupation as a laborer and limited recollection of the wound’s onset, the origin and duration of the ulcer remained unclear. Following an urgent surgical incision, drainage, and debridement in the operating room, Ricardo was placed on negative pressure wound therapy (NPWT) using a KCI wound vacuum. The initial wound size measured approximately 150 cm².

Patient Profile

• Age: 48

• Ethnicity: Hispanic

• Medical History: Type II diabetes mellitus

• Wound Location: Dorso-lateral left foot, involving the fifth digit and extending to the ankle

• Complication: Gas gangrene

• Occupation: Laborer

• Wound History: Unknown onset, poor recall due to occupational demands

Objective

To achieve full healing of a complex diabetic foot ulcer with gangrene through advanced wound care management, improve glycemic control, and implement preventive strategies to reduce the risk of recurrence.

Treatment Protocol

1. Wound and Vascular Assessment
A comprehensive evaluation was conducted, including:

• Detailed wound examination

• Monofilament testing for neuropathy

• Ankle-Brachial Index (ABI) and Toe-Brachial Index (TBI)

• Transcutaneous oxygen pressure (TcPO₂) and skin perfusion pressure

• Noninvasive vascular imaging to rule out peripheral arterial disease (PAD)

2. Ulcer Classification
The ulcer was classified based on etiology (neuropathic, ischemic, or neuroischemic), guiding the development of an appropriate treatment plan.

3. Glycemic and Lipid Management
Coordinated care ensured optimal blood glucose and lipid control to support immune function and enhance healing.

4. Nutritional and Lifestyle Support
Ricardo received counseling on diabetic-friendly nutrition, smoking cessation, and sustainable lifestyle changes to improve systemic health and healing capacity.

5. Advanced Wound Therapies

• Ultramist Therapy: Administered 1–2 times weekly to stimulate tissue regeneration and reduce bacterial bioburden.

• Amniotic Tissue Grafts: Applied for their anti-inflammatory and regenerative properties, secured with adaptic non-adherent contact layers and moisture-retentive dressings.

6. Prevention Strategy
A long-term management plan was implemented, including custom diabetic footwear, ongoing patient education, and routine podiatric follow-up to minimize the risk of future ulceration.

Results

• Initial Response: Noticeable tissue improvement was seen at the first dressing change.

• By 5 Weeks: Significant reduction in wound size and resolution of gangrenous tissue.

• At 3 Months: Complete wound healing and closure were achieved, with restoration of skin integrity and no signs of reinfection.

Conclusion

This case exemplifies the successful resolution of a complex, gangrenous diabetic foot ulcer through a multidisciplinary, evidence-based approach. The integration of surgical intervention, advanced wound care therapies, diabetic management, and preventive strategies enabled full healing within three months. Early improvements underscored the effectiveness of the treatment regimen, reaffirming the importance of timely, comprehensive care for diabetic patients facing limb-threatening ulcers.