The role of holistic assessment, multidisciplinary diagnosis and treatment, and negative-pressure wound therapy with instillation in managing complex diabetic foot ulcers: a case-based discussion.

The etiology of diabetic foot ulcers (DFU) is multifactorial, encompassing neuropathy, peripheral arterial disease, and susceptibility to infection. The management of DFU remains challenging due to high recurrence rates and amputation risks. While various treatments exist, a standardized, effective approach integrating holistic care is essential. This paper presents a detailed analysis of two representative cases of complex DFU managed within our institution. Both patients underwent a structured process involving immediate holistic assessment, formation of an MDT to devise personalized treatment strategies, surgery, application of NPWTi, and structured post-discharge planning including health education. Eventually, both patients achieved successful wound closure without major amputation. The successful management of complex DFU necessitates a paradigm shift from isolated interventions to a comprehensive strategy. This strategy should encompass 1) early holistic patient assessment, 2) centralized coordination via an MDT for personalized care plans, 3) meticulous surgical debridement, 4) judicious use of advanced adjunctive therapies like NPWTi, and 5) robust post-discharge follow-up and patient education to prevent recurrence. This framework serves as a practical guide until further robust evidence emerges to refine these recommendations.