{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:50:38Z","timestamp":1782384638466,"version":"3.54.5"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic diabetic foot ulcers remain a major clinical challenge, particularly when complicated by tendon exposure and failure to respond to standard care. We report a 47-year-old male with Type II diabetes mellitus with a history of smoking who developed a chronic ulcer of the fourth web space of the left foot. Following resolution of an initial soft tissue infection, the wound progressed to a non-healing ulcer with exposed but viable extensor digitorum longus tendon. Despite guideline-directed management, healing plateaued. Adjunctive Erbium:YAG laser therapy was introduced only after failure of prolonged standard conservative management as a secondary intervention, resulting in progressive wound contraction, tendon coverage, and complete epithelialization by 8 weeks. This case illustrates a stepwise approach to chronic diabetic foot ulcer management and the potential role of laser therapy after failure of standard care.<\/jats:p>","DOI":"10.1093\/jscr\/rjag109","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:42:10Z","timestamp":1770295330000},"source":"Crossref","is-referenced-by-count":0,"title":["Breaking the stalemate: a case of a laser-accelerated healing of a chronic tendon-exposed diabetic foot ulcer"],"prefix":"10.1093","volume":"2026","author":[{"given":"Mohamed Hamdy","family":"Serour","sequence":"first","affiliation":[{"name":"Department of General Surgery, Farwaniya Hospital , PO Box 13373, Kuwait City ,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2958-438X","authenticated-orcid":false,"given":"Hussain","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Jaber AlAhmad Hospital , PO Box 2270, Kuwait City ,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Aziza","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Farwaniya Hospital , ,","place":["Kuwait"]},{"name":"PO Box 13373, Kuwait City , ,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Samir","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Farwaniya Hospital , ,","place":["Kuwait"]},{"name":"PO Box 13373, Kuwait City , ,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AbdulAziz","family":"Almaheed","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Farwaniya Hospital , PO Box 13373, Kuwait City ,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naser","family":"Al-Humaidi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Farwaniya Hospital , PO Box 13373, Kuwait City ,","place":["Kuwait"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"2026062506223615200_ref1","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1016\/S0140-6736(05)67698-2","article-title":"The global burden of diabetic foot disease","volume":"366","author":"Boulton","year":"2005","journal-title":"Lancet"},{"key":"2026062506223615200_ref2","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"key":"2026062506223615200_ref3","doi-asserted-by":"publisher","first-page":"645","DOI":"10.2337\/dc17-1836","article-title":"Current challenges and opportunities in the prevention and management of diabetic foot 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2023)","volume":"77","author":"Senneville","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026062506223615200_ref7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/1534734612447802","article-title":"Dermal substitute template use in diabetic foot ulcers: case reports","volume":"11","author":"Alagaratnam","year":"2012","journal-title":"Int J Low Extrem Wounds"},{"key":"2026062506223615200_ref8","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.2337\/diacare.26.6.1879","article-title":"Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial","volume":"26","author":"Sheehan","year":"2003","journal-title":"Diabetes Care"},{"key":"2026062506223615200_ref9","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1053\/j.jfas.2019.07.023","article-title":"Erbium: yttrium aluminum garnet laser accelerates healing in indolent diabetic foot ulcers","volume":"58","author":"Johnson","year":"2019","journal-title":"J Foot Ankle Surg"},{"key":"2026062506223615200_ref10","doi-asserted-by":"crossref","first-page":"e70688","DOI":"10.1111\/iwj.70688","article-title":"Erbium:yttrium aluminium garnet (Er:YAG) laser therapy versus sharp debridement in the management of chronic ulcers of the lower extremity: a randomised control trial","volume":"22","author":"Zaitsev","year":"2025","journal-title":"Int Wound J"},{"key":"2026062506223615200_ref11","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1111\/wrr.12764","article-title":"Er:YAG laser vs. sharp debridement in management of chronic wounds: effects on pain and bacterial load","volume":"28","author":"Hajhosseini","year":"2020","journal-title":"Wound Repair Regen"},{"key":"2026062506223615200_ref12","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1742-481X.2008.00466.x","article-title":"Clinical outcome of diabetic foot ulcers treated with negative pressure wound therapy and the transition from acute care to home care","volume":"5","author":"Wu","year":"2008","journal-title":"Int Wound J"},{"key":"2026062506223615200_ref13","doi-asserted-by":"publisher","first-page":"e026345","DOI":"10.1136\/bmjopen-2018-026345","article-title":"Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT","volume":"10","author":"Seidel","year":"2020","journal-title":"BMJ Open"}],"container-title":["Journal of Surgical Case 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