Ischemic toe ulcer secondary to Buerger’s disease managed with low-pressure negative pressure wound therapy and a moisture-preserving interface: a case report

Introduction and importance: Buerger’s disease (thromboangiitis obliterans) is a non-atherosclerotic inflammatory vasculopathy characterized by distal ischemia and impaired wound healing. Management of ischemic ulcers in affected patients is challenging, and conventional wound-care strategies may fail due to profound microvascular compromise. Despite the patient’s advanced age, the clinical presentation and vascular findings were consistent with Buerger’s disease-like distal ischemic vasculopathy after the exclusion of other causes of distal ischemia. Presentation of case: We report the case of a 71-year-old male chronic smoker who presented with a painful, non-healing ulcer on the left great toe. Vascular imaging demonstrated preserved proximal arterial patency without hemodynamically significant stenosis, while distal perfusion was reduced. Following extensive surgical debridement, negative pressure wound therapy (NPWT) was initiated. Early marginal necrosis developed when it was applied directly to the wound bed. Subsequent modification of the technique, using low-pressure continuous NPWT (−50 mmHg) combined with a moisture-preserving interface, led to progressive granulation tissue formation, wound contraction, and epithelialization, resulting in sustained wound healing. Clinical discussion: In ischemic wounds associated with Buerger’s disease, direct application of NPWT may exacerbate tissue injury due to desiccation and microvascular compromise. Introducing a moisture-preserving interface beneath low-pressure NPWT can help maintain tissue hydration, protect fragile ischemic tissue, and optimize the wound microenvironment. Conclusion: This case highlights the importance of tailoring NPWT techniques to the underlying vascular pathology. Low-pressure NPWT, combined with a moisture-preserving interface, may represent a useful approach for managing ischemic wounds in patients with Buerger’s disease.