Poorly controlled long standing diabetic

• Ejection fraction
• 12% ABI 15%
• Gangrenous lower extremity wound with Achilles tendon involvement

Patient stated he had self treated wounds for 3 months before coming to wound center

Patient received care at wound center using a number of dressings – wound over Achilles tendon would not close due to traction of subcutaneous tissue each time patient took a step.

• DermaFill applied after 16 weeks of wound care
• DermaFill placed over wound and Unna's boot used to reduce movement

7 Days of Unna's boot therapy

11 week follow-up

• Patient states last of DermaFill dressing fell off 3 weeks earlier