<![CDATA[Background: Severe diabetic foot ulcers (DFUs) with extensive necrotic tissue require effective wound-bed preparation to reduce bioburden and promote granulation. Zinc-chitosan nanofibers possess antimicrobial, immunomodulatory, and moisture balance properties that may enhance wound healing. However, clinical evidence for their use in high-grade necrotic DFUs remains limited.Aims: This case series evaluated the effectiveness of zinc-chitosan nanofibers as a primary dressing for high-grade diabetic foot ulcers with extensive necrosis.Methods: This prospective observational case series included three purposefully selected adults with high-grade DFUs containing 80% slough. Wounds were assessed at baseline and week 1, 2, and 4 using the DMIST scoring system. Tissue perfusion was evaluated using the ankle brachial pressure index (ABPI), while laboratory investigations included blood glucose, glycated hemoglobin, serum albumin, and leukocyte count. Standardized wound care comprised hypochlorous acid cleansing, staged autolytic and mechanical debridement, moisture balance optimization, zinc-chitosan nanofibers as the primary dressing, foam and multilayer secondary dressings, and culture-guided antibiotic therapy.Results: ABPI values of 0.8 to 0.9 conformed adequate perfusion for debridement. ABPI values of 0.8 to 0.9 conformed adequate perfusion for debridement. By week 2, DMIST scores decreased to 21 to 23, with reduced necrosis and early granulation. By week 4, all wounds achieved a DMIST score of 10, with 80 to 95% granulation tissue, marked reductions in exudate and infection, resolution of inflammation, and early epithelialization.Conclusion: Zinc-chitosan nanofibers showed promising clinical benefit as a primary dressing by accelerating wound-bed preparation in severe necrotic DFUs. Large controlled studies are needed to confirm efficacy and establish clinical recommendations.]]>
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