~60-year-old woman in rural Ghana with undiagnosed diabetes had extensive R foot abcesses of over 3 months duration. Pain sensation to deeper tissues of foot prevented weight-bearing, but unaware of extent of wounds. No prior treatment.

Cursory wound exploration revealed exudate deep in foot and destroyed joints, so open areas packed, sent to distant hospital for surgical debridement. Muslim, but expected, receptive to Christians' prayers as part of treatment. Refused injections but accepted oral antibiotics, anti-hyperglycemics. Need to continue medications and obtain surgical debridement immediately stressed.

Surgeon unavailable. Patient returned demanding surgical debridement from clinic. Next morning, patient cooperated for extensive debridement, removal of three phalanges and proximal metatarsal using improvised equipment without any anesthetic.

Most moist dressings led to dramatic infections in this setting, but polymeric membrane dressings contain a cleanser. Silver polymeric membrane dressings not available. Therefore, standard polymeric membrane dressings initiated.

Plain polymeric membrane wound filler inserted into sole wound cavities, proximal edge of foot (where bones removed) and through tunnel at great toe, so all wounded surfaces in contact with active dressing. Filler covered with standard polymeric membrane dressings. Forefoot wrapped with bedsheet strips to keep out dust. Daily dressing changes first few weeks. Blood and bits of slough on dressing surfaces, but wound beds consistently clean. No manual cleansing done. Wound beds filled in quickly. When sole of foot cavity filled in, area permitted to seal shut. Cavity along proximal edge of foot filled in more gradually; polymeric membrane wound filler used there almost to complete closure.

Infection cleared quickly following aggressive sharp debridement. All wounds closed within 8 weeks. Woman retained ambulation abilities.

Polymeric membrane wound filler, dressings kept diabetic foot wound clean and supported extremely rapid healing.