Abstract
Diabetes mellitus represents a major global health challenge, with over 537 million adults currently affected worldwide. Among its complications, diabetic foot ulcers remain a leading cause of morbidity, hospitalization and amputation, imposing a significant socioeconomic burden. Effective management requires a multidisciplinary approach integrating surgical, medical and rehabilitative expertise. Negative pressure wound therapy has demonstrated clinical efficacy in promoting granulation tissue formation, accelerating wound healing, and reducing infection rates compared with conventional dressings. This case series presents the management of four frail, septic patients with severe diabetic foot ulcers treated between 2023 and 2025 in an academic surgical department. All patients required surgical intervention, including debridement or partial amputation, combined with negative pressure wound therapy and, in selected cases, revascularization or skin grafting. One case utilized an electrospun nanofiber dressing which enhanced wound granulation and shortened healing time. Outcomes varied according to systemic comorbidities, vascular status and glycemic control; however, NPWT consistently supported wound stabilization and preparation for definitive closure. These findings reinforce the essential role of interdisciplinary collaboration and advanced wound technologies in the treatment of complex diabetic foot infections, particularly in frail or septic patients, and highlight the potential of nanofiber-based dressings as adjunctive therapies in comprehensive diabetic foot care.