Fig.1 Day 1; tendon exposed diabetic foot ulcer

The patient was using regular gauzes to dress the ulcer, but the tendon was at risk of dehydration tensions and necrosis. The patient was referred to a surgeon for surgical treatment, but due to his cardiovascular conditions, the medical team decided to perform non-surgical methods.

In order to manage diabetes; Initial laboratory results indicated a HbA1C of 9.2% and mean blood glucose of 226mg/dl. Synoripa 5/500 BD and daily dose of Gliclazide 30 mg were prescribed. The wound care nurse provided education on off-loading and diabetic diet tips. By the 10^th day, the fasting blood sugar returned to the normal range. Dressing of the ulcer using silver dressings and hydrogels commenced, and betaine-polyhexanide solution was used as a proper disinfectant in every dressing session. After 20 days of every two days dressing, the healing process seemed to be very slow. Considering the tendon-exposed, time was extremely vital for the medical team to save the tendon by granulating the ulcer. Therefore, as the ulcer had a margin of granulated tissue, 0/5 gram of collagen powder along with Phenytoin ointment was used each session to boost the granulation process. Furthermore, as complementary treatment, the patient underwent ozone therapy by 70 mcg/dl(1). Local ozone therapy was conducted using a plastic tent on the patient’s foot over 24-days period in 12 sessions. By the day 44, the ulcer was totally granulated, and the Achilles tendon seemed to be safe (figure.2).