A 56-year-old, male, diabetic type 1 patient, with a previous diagnosis of diabetic foot disease, presented to our unit after sustaining a deep dermal burn. His wounds extended on the lateral aspect of his ankle and foot, 1.5% TBSA, as the result of prolonged contact with a hot water bottle (Figure 8). The HbA1c levels for this patient were of 102 mmol/mol. The patient had a previous history of ischaemic heart disease and coronary stenting. Due to the suspicion of peripheral vessel disease, a computed tomography angiography (CTA) was organised pre-debridement, showing bilateral atherosclerotic disease on his lower extremities, but no signs of clinically significant lumen stenosis.
Chlorhexidine-soaked gauze was used to prepare the wounds for enzymatic debridement, which took place three days after the injury. After a successful NexoBrid debridement, under a spinal block, the patient requested to be discharged and advice on leg elevation and modifications to his insulin regime were given. Two days later he presented with desiccated wounds and a new eschar (Figure 9). He subsequently underwent wound excision and split skin grafting. Even though it was documented at one week postoperative a 70% graft take, during the following week the lateral portion of the sole and heel declared as necrotic. Three weeks after the first surgical debridement, a second debridement and skin grafting of the resulting wound was performed, achieving a healed wound 8 weeks after the injury.