Platelet-rich plasma combined with multimodal therapy for diabetic foot ulcer with tophi: a case report

Objective: To evaluate the comprehensive therapeutic value of platelet-rich plasma (PRP) combined with antibiotic-loaded bone cement, systemic metabolic management, and topical herbal preparation for diabetic foot ulcer (DFU) with tophi. Methods: A 55-year-old male with tophaceous DFU received multimodal treatment, including debridement, antibiotic-impregnated bone cement implantation, local autologous PRP injections, topical Xiang Lei Tang Zu Ointment, and systemic control of glucose and uric acid. Efficacy was assessed via wound area, laboratory tests, and imaging. Results: After 4 months, the ulcers were nearly healed with significant reduction in wound area, healthy granulation tissue, and complete re-epithelialization. Serum uric acid decreased from 564 μmol/L to normal range, alongside reduced inflammatory markers. Conclusion: This multimodal strategy integrating local anti-infection, bioactive repair, topical agents, and systemic regulation effectively controlled infection, promoted tissue regeneration, and improved the metabolic microenvironment, offering a promising integrative model for refractory tophaceous DFU.