Purpose:
The role of ON101 cream (Fespixon, Oneness Biotech) for diabetic foot ulcers has been well established in randomized clinical trials. However, lack of studies reports the clinical practice in patients with multiple co-morbidities along with diabetes mellitus. The present study shows our experience of limb salvage in a patient who suffered from multiple co-morbidities.

Materials and Methods:
This is a retrospective case study. A 61-year-old male patient, who with underlying disease as type 2 diabetes mellitus, peripheral arterial occlusion disease, chronic kidney disease stage 3 under hemodialysis, coronary artery disease s/p plain old balloon angioplasty, rheumatic arthritis, moderate mitral valve regurgitation and tricuspid valve regurgitation, suffered from a wet gangrene on right heel. The lesion developed with pus discharge, and the wound culture yielded Proteus and Enterococcus. After debridement, the calcaneus exposure was noted, and the pathology showed osteomyelitis. Sequestrectomy was performed till the wound culture showed negative. Percutaneous trans-luminal angioplasty was also done for correction of peripheral arterial occlusion. The wound was cared with wet dressing, and then moisturizing gel with absorbent dressing for weeks. However, poor granulation formation was noted. Because of high operation risks and poor limb arterial perfusion, flap was also not indicated for reconstruction.

Results:
ON101 cream was prescribed with absorbent dressing for wound care (twice a day). The granulation formation improved obviously, and the calcaneus bone was totally covered within 4 weeks. Split-thickness skin grafting was performed, and the patient was discharged without complication.


Conclusion:
Patients with multiple co-morbidities are not indicated for lots of reconstructive surgery. Wound re-infection may happen in the prolonged wound healing process, and limb sacrifice should be done. In the present case, ON101 cream showed promising effect on difficult wound healing, and played a role in limb salvage.