Lower Extremity Salvage Through Dextranomer Debridement and Evolution Toward a Functional Pincer in a Diabetic Foot: Experience in Rural Surgery.

Necrotizing infections of the diabetic foot associated with peripheral vasculopathy remain a critical challenge in emergency and general surgical practice, particularly in low-resource, second-level rural hospitals that lack access to reconstructive subspecialties. We report the case of a 57-year-old man with type 2 diabetes mellitus and peripheral vascular disease who presented to a rural, second-level public hospital in Linares, Nuevo León, Mexico, with a deep, contaminated surgical wound following a prior amputation of the second and third toes of the left foot performed at another rural facility. On admission, he had poor glycemic control, local pain, and a wound bed with abundant slough, debris, fibrin, and liquefactive necrosis threatening progression toward the lateral metatarsals. Management consisted of titrated insulin therapy, broad-spectrum systemic antimicrobials (imipenem and vancomycin), and formal surgical debridement with mechanical washout using saline and iodine solution. Postoperatively, topical dextranomer microbeads (Debrisan) were applied serially to the wound bed to promote continuous autolytic debridement. Dextranomer controlled exudate and mechanically removed fibrin by capillary action without impairing angiogenesis, halting necrotic progression and accelerating the transition to a clean, flat wound bed with highly viable granulation tissue. Guided healing and biological retraction ultimately produced a functional interdigital pincer deformity that preserved plantar weight-bearing, avoiding a major proximal amputation after an 18-day hospital stay. This case illustrates that dextranomer is a low-cost, high-utility adjunct to aggressive surgical debridement for complex, infected diabetic foot wounds in resource-limited rural settings, and that a functional pincer-type anatomical outcome can preserve independent ambulation while avoiding infracondylar amputation.