Abstract
Foot ulcer due to diabetes and/or peripheral arterial disease (PAD) frequently results in an intractable condition that is refractory to treatment. To manage such a condition, we developed a combination therapy consisting of conventional conservative therapy and surgery. This aggressive conservative treatment comprising aggressive debridement, trafermin (Fiblast Spray, Kaken, Japan) treatment and negative pressure wound therapy (NPWT) was adopted to treat 21 patients with diabetes and PAD-related refractory foot ulcer accompanied by bone exposure. Except for one patient who died during treatment, the remaining 18 patients obtained limb salvage. The mean time to cure was 5.7 months. This approach should be considered before proceeding amputation. Some patients may refuse amputation or cannot tolerate highly invasive surgical treatment including tissue transplantation. In such cases, this aggressive conservative therapy can be indicated as an excellent and repeatable technique requiring simple manipulation.
