Eight-month functional and scar outcomes following conservative management of an extensive diabetic foot soft-tissue defect using high-purity type I collagen matrix and negative pressure wound therapy: a case report

Extensive diabetic foot defects with exposed tendons are typically managed with debridement followed by skin grafting or flap reconstruction. We report the 8-month outcome of a 45-year-old man with poorly controlled type 2 diabetes mellitus who developed a 17 × 10 cm post-infective dorsal foot defect with exposed extensor tendons after drainage of a diabetic foot abscess. The patient declined reconstructive surgery because of financial constraints and inability to interrupt daily-wage employment. Following shared decision-making, sequential applications of a high-purity type I collagen (HPTC) matrix combined with portable negative-pressure wound therapy (NPWT) achieved progressive granulation, epithelialization, and complete wound closure within 7 weeks without grafting or flap reconstruction. At 8 months, the wound remained completely healed with satisfactory scar maturation, preserved foot function, unrestricted ambulation, return to work, and no recurrent ulceration or infection. This case demonstrates the potential of an HPTC matrix combined with NPWT as a limb-salvage strategy in carefully selected patients unsuitable for conventional reconstruction.