Figure 1.

Male patient with a history of bilateral ischemic diabetic foot ulcers. No revascularizable lesions were found on angiography and the patient repeatedly refused amputation, opting for local wound care, including hyperbaric oxygen therapy, despite multiple inpatient admissions for failure to thrive, wound infections, and osteomyelitis. Patient had dry gangrene of the left distal foot (a,b), resulting in progressive loss of the left 4^th toe (c), left 2^nd and 3^rd toes (d), and ultimately, a transmetatarsal amputation (e). Currently, the patient is receiving a regenerative medicine product in combination with a vacuum-assisted closure device and has decreased pain and wound size.