Therapeutic Advancement in Diabetic Foot Ulcer Management: Promotion of Dermal Tissue Repair and Regeneration Using Xenograft-Derived Biomaterials and Regenerative Strategies

Abstract

Diabetic foot ulcers (DFUs) represent a major global health challenge and are among the most severe and debilitating complications of diabetes mellitus. Chronic non-healing wounds in diabetic patients are often associated with impaired vascularization, increased risk of infection, and prolonged inflammation, frequently resulting in poor outcomes, including amputation. The advent of advanced wound care technologies has introduced regenerative biomaterials that aim not only to cover wounds but also to promote true tissue regeneration. This case study presents a 60-year-old male with a long-standing history of insulin-dependent diabetes mellitus who presented to CMC Hospital in Erbil with acute symptoms of severe pain, fever, and inability to ambulate due to an inflamed, necrotic ulcer located on the lateral heel of the right leg. Clinical evaluation revealed cyanosis and local hyperthermia, suggestive of deep tissue infection and vascular compromise. Following emergency surgical intervention, which included debridement and evacuation of necrotic and infected material, the patient was referred to the Chronic Wound Management Department (Dr. Saif Clinic) within the same hospital for advanced care. A comprehensive wound management protocol was implemented, incorporating the application of xenograft-derived extracellular matrix (ECM) from ovine forestomach and serial sessions of negative pressure wound therapy (NPWT) at-125 mmHg. Over the course of 20 weeks, the patient received multiple sessions of ECM application and NPWT, accompanied by supportive medical care and strict glycemic control. Remarkable improvement was observed throughout the treatment period. The wound demonstrated progressive granulation, neovascularization, and tissue remodeling, ultimately resulting in complete dermal regeneration. Importantly, the healing was achieved without scar formation, and full functional restoration of the affected limb was noted. This case underscores the therapeutic potential of integrating xenograft-derived ECM scaffolds with NPWT in the management of complex DFUs. Such regenerative strategies not only support wound closure but also actively stimulate the body's intrinsic healing processes, offering hope for improved clinical outcomes in high-risk diabetic patients. The success of this case highlights the critical role of multidisciplinary, technology-enhanced wound care in preventing diabetic foot-related disabilities and amputations.

Keywords: Dermal regeneration, Diabetic foot, Xenograft