Preserving the Limb in Severe Diabetic Foot: A Case Study in Integrated Wound Management
Case Performed By: Prof. Dr. H. Erhan Güven
Presented at: 35th EWMA-GNEAUPP Conference, Barcelona, 2025
Diabetic foot complications continue to present significant challenges in clinical practice, particularly when ulcers are advanced and compounded by infection and systemic deterioration. This case, presented by Prof. Dr. H. Erhan Güven, demonstrates how a strategic and timely combination of surgical and advanced topical approaches can shift the outcome dramatically, even in cases initially referred for major amputation.
Case Overview
A 51-year-old male with a 10-year history of diabetes and a 30 pack-year smoking history presented with severe injuries to his right foot following the use of a hot water bag and a heater, leading to thermal burns.
In an attempt at self-treatment, he applied an ice bag to the same area for five consecutive days, which resulted in a cold burn. The combination of heat and cold exposure caused extensive tissue damage.
On examination, the patient exhibited multiple Wagner grade 4 diabetic foot ulcers on his right foot, with wound dimensions measuring 13×5 cm, 5×7 cm, and 5×9 cm. He was diagnosed with necrotizing fasciitis and systemic sepsis, with markedly elevated inflammatory markers, including a C-reactive protein (CRP) level of 333 mg/L, necessitating emergency admission to the surgical department.
Multimodal Treatment Strategy
The clinical team pursued an intensive limb salvage protocol over 112 days of inpatient care. Key components of the treatment included:
➡️ Surgical sharp debridement to remove necrotic tissue and arrest the progression of infection
➡️ Early application of Topical Desiccating Agent (TDA) to rapidly eliminate devitalized tissue, infection, and biofilm.
➡️ Adjunctive advanced therapies: Negative Pressure Wound Therapy (NPWT), Epidermal Growth Factor (EGF) application, interval split-thickness skin grafting with NPWT, and application of skin substitute over the graft
Clinical Outcomes
This aggressive, integrated approach resulted in a series of positive outcomes:
A single application of a topical desiccating agent (TDA) in the early phase of treatment proved effective in controlling the necrotizing infection, enabling an uncomplicated granulation process.
This case demonstrates that even in patients with advanced diabetic foot ulcers complicated by life-threatening infections, a combination of aggressive initial interventions and appropriate wound care products can reduce the risk of amputation.
Timely, targeted treatment decisions remain critical in achieving limb preservation outcomes.
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𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗲𝗱 𝗔𝗿𝘁𝗶𝗰𝗹𝗲𝘀:
✅ Single-Application Biofilm Removal: https://lnkd.in/d-wvAcZD
✅ Powerful Anti-Biofilm Agent Restarts Wound Healing in 60 Seconds: https://lnkd.in/dk_rKDw4
✅ Accelerating Granulation in Wound Healing: https://lnkd.in/dFki_8kc
✅ Role of T.I.M.E.R.S. in Standard of Wound Care: https://lnkd.in/d7NBfk6g
✅ Different Methods of Debridement: An Overview: https://lnkd.in/dDsF-4FR
✅ Combining an Acidic Compound and NPWT: https://lnkd.in/dYAMdN3F
✅ Stabilization of an End-Stage Wound in a Vascular Compromised Amputated Case: https://lnkd.in/dyRgTy8z
✅ Cost-effectiveness of DEBRICHEM®: https://lnkd.in/dQfipWS2
✅ DEBRICHEM® INNOVATING THE FUTURE OF WOUND CARE: https://lnkd.in/dYpwfG-m
✅ Clinical Trial on Chemical Debridement: https://lnkd.in/drw_dN92
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