A 44-year-old, male, type 2 diabetic patient with a previous diagnosis of diabetic foot disease, was referred to our unit after sustaining a 2.5% total body surface area (TBSA) deep dermal burn to his bilateral soles after falling asleep while resting his feet against a radiator (Figures 1 and 2). He presented one day after the injury and on that day the wounds were cleaned and dressed with chlorhexidine-soaked gauze. Routine blood testing demonstrated haemoglobin glycated levels (HbA1c) of 106 mmol/mol. Other comorbidities included peripheral vascular disease with an ABPI of 1.4 (right) and 0.8 (left).
The following day, NexoBrid was applied to the wounds, obtaining a satisfactory debridement (Figures 3 and 4). A spinal block was used to avoid any unexpected discomfort while enzymatic debridement took place. The area was then dressed for 2 hours with chlorhexidine-soaked gauze which was later replaced by lyophilised porcine skin (Xenoderm, Ideal Medical Solutions) and moist gauze. This patient was kept hospitalised with strict elevation of his lower extremities.
At his first dressing change three days later, the clinical team noticed that a new eschar had formed, suggesting a deepening of his previously viable debrided wounds (Figure 5 and 6). Over a period of four weeks, this patient underwent three surgical debridements along with the use of topical negative pressure dressings, until a suitable wound bed was obtained. Split skin grafting was performed at that stage with good results (Figure 7), achieving wound healing in 6 weeks post injury.