Healing effects of Traditional Chinese Medicine plaster Heiyu Gao on refractory diabetic foot ulcers: a case series of ultra-elderly patients with surgical contraindications.

Debridement surgery and revascularization are essential procedures for treating refractory diabetic foot ulcers (DFUs). However, a significant therapeutic gap exists for patients deemed at prohibitively high surgical risk. We report a case series of three nonagenarian patients (aged 95, 94, and 96 years) with Wagner grade 4 DFUs in whom conventional treatments had failed and surgery was absolutely contraindicated. Two proprietary Traditional Chinese Medicine (TCM) black plasters, designated as Heiyu Gao A and B based on century-old formulations, were externally applied to the ulcers and surrounding skin. The uniqueness of these cases lies in their extraordinary clinical challenges and remarkable treatment outcomes. Complete ulcer healing was achieved in all patients within 27, 105, and 96 d, respectively, without requiring revascularization or surgical debridement. Treatment demonstrated two novel features: tissue-intelligent selective autolytic debridement targeting only necrotic tissue, and concurrent regenerative repair at wound margins. All patients experienced significant pain reduction within three days of initiating treatment. The healing was characterized by absence of scarring and restoration of normal skin architecture. The follow-up periods ranged from 95 to 580 d, with no recurrence observed. These findings suggest that TCM black plasters may offer an effective alternative for high-risk patients currently relegated to palliative care pathways.