Innovative treatment of diabetic ulcers: combining chemical debridement and xenograft applications: a case study

Lower extremity diabetic ulcers (LEDUs) are a common, high-morbidity complication of diabetes, frequently leading to infections, hospitalisations and emergency department visits. This case study examines the treatment effectiveness of a novel wound care approach in a 57-year-old female patient with a hard-to-heal LEDU (a diabetic foot ulcer of the left lower extremity) complicated by poorly controlled diabetes (glycated haemoglobin A1c: 13%). Initially, standard of care (SoC) practices, including alginate dressings, hypochlorous acid gel and sharp debridement, were ineffective in promoting significant healing. This case was further challenged by its occurrence in the remote setting of Tongatopu within the Kingdom of Tonga, where advanced wound care materials and even SoC products are not consistently available, underscoring the need for innovative and adaptable treatment strategies. A new regimen was subsequently initiated that involved preparing the wound bed through chemical debridement using a topical desiccating agent (TDA) with methanesulfonic acid (DEBRICHEM, DEBx Medical, the Netherlands), which has the ability to denature proteins and reduce microbial biofilms, necrotic tissue and inflammatory proteins in the wound bed. This was followed by the application of ovine forestomach matrix (OFM) grafts containing hyaluronic acid (Symphony, Aroa Biosurgery, New Zealand), which was applied at approximately 12-day intervals. Over the 110 days following the initial application of the TDA, the LEDU showed significant improvement as it progressed along the healing cascade towards closure. This case report provides insights into the potential of combined desiccating chemical debridement and xenograft-based wound care in treating hard-to-heal LEDUs, highlighting an approach that could inform future clinical practices in diabetic wound care.