Background Nitric Oxide Generating Dressing (NOGD) has been shown in RCTs to improve wound healing as well as being a multimodal wound dressing with antimicrobial property. However very ischaemic wounds were excluded from the originalRCT

Aim: To evaluate the potential clinical benefit of an NOGD in highly ischaemic DFUs that had remained static or demonstrated recurrent tissue necrosis despite successful revascularisation and best standard of care (SoC)

Method: A retrospective review of a single-centre case series. Three consecutive patients with highly ischaemic DFUs (Wagner Grade 4 with localised necrosis). Patients were given NOGD as well as their normal SoC

Conclusion: This case series suggests that an NOGD multimodal dressing may support healing in selected highly ischaemic wounds that remain static or deteriorate despite revascularisation and standard care.