A 53-year-old female with type 2 DM (HbA1c 11.7%) , peripheral artery disease (PAD) , hypertension, and hyperlipidemia was sent to the emergency room of Kaohsiung Medical University Hospital due to presence of an infected DFU with exposed tendon and ischemic necrosis (Figure 1a) . Ankle brachial index of her right leg was 0.8 and angiography revealed severe stenosis over posterior/anterior tibial artery. The ulcer was downgraded from Wagner grade IV to II after a 10-day treatment by broad-spectrum antibiotics and angioplasty for infection and ulcer severity control. However, the tissue proliferation was halted by persistent inflammation and ischemia (Figure 1b) . The growth of granulation tissue was limited despite using fat grafting to boost mesenchymal tissues. Pseudomonas contamination occurred after a 3-month care. We tried artificial dermis after further debridement and intravenous antibiotics but noted poor ingrowth of cells. The patient declined the recommended surgical reconstruction with flap coverage so ON101, a topical macrophage-regulating drug, was applied twice a day. The ulcer area measured digitally by imitoMeasure, was 7.23cm2 before treated by ON1 (Figure 1c) and reached closure (Figure 1d) after 16 weeks. Wound healing is often hindered by DM or PAD despite of multiple interventions. Macrophage-regulation can be deemed as a novel approach to promote tissue repair and salvage difficult wounds.
S.Chen: Employee; Oneness Biotech Co., Ltd. Y.Lin: None. J.Chen: Employee; Oneness Biotech Co., Ltd. Y.Kuo: None.