title: Collagen implant with gentamicin sulphate as an option to treat a neuroischaemic diabetic foot ulcer: Case report.
abstract: BACKGROUND
  The ischaemic diabetic foot is associated with a faster evolving atherosclerosis affecting preferentially the bellow knee arteries. This distal ischemia associated with a wide distribution of multiple stenosis and occlusions throughout lower limb arteries, makes revascularization very hard or even impossible. This represents a major factor responsible for non-healing diabetic foot ulcer. In these cases all efforts should be made to find treatment alternatives that can promote ulcer healing.
  
  
  METHODS
  Male patient with neuroischaemic diabetic foot ulcer with exposure tendon, without possibility for endovascular or surgical revascularization, was treated unsuccessfully with prostaglandin and several types of dressings for 7 months. Skin graft failed. Weekly dressings with collagen implant impregnated with gentamicin sulphate were then started and continued in an outpatient setting. Evolution was very positive, with 99% of epithelisation in 9 months. No pain or infection since the beginning of this treatment.
  
  
  CONCLUSIONS
  Successful treatment of a neuroischaemic diabetic foot ulcer rests with the possibility of increasing the perfusion to the foot. Whether or not a revascularization procedure is possible will set the tone for the ensuing treatment. Using collagen implant with gentamicin sulphate, collagen is delivered to the wound bed helping in the granulation tissue formation, will increase microcirculation, and topic gentamicin will decrease bacterial load, exudate and proteases production, increasing cicatrisation.
  
  
  CONCLUSIONS
  In neuroischaemic diabetic foot ulcer weekly dressings with collagen implant impregnated with gentamicin sulphate can be a good option for ulcer healing.
authors.affiliation: Centro Hospitalar e Universitário de Coimbra (Covões), Surgery C, Centro Hospitalar de Coimbra (Covões), Quinta dos Vales, São Martinho do Bispo, Coimbra, Portugal. Electronic address: carloscostaalmeida@yahoo.com.
authors.forename: C E
authors.initials: CE
authors.lastname: Costa Almeida
keywords: Collagen implant; Diabetes; Diabetic foot; Neuroischaemic foot