A 70-year-old man with Type 2 Diabetes Mellitus presented with an extensive diabetic leg ulcer while receiving chronic hemodialysis for end-stage renal disease. Extensive soft-tissue necrosis and severely impaired healing created a high risk of limb loss, requiring prompt surgical management.

Radical surgical debridement was performed to remove all necrotic tissue until healthy, viable margins were achieved. Careful wound bed preparation preserved the surrounding healthy tissue and promoted progressive granulation and secondary healing. Compression therapy with elastic bandaging was also applied to control edema and optimize the healing environment.

The wound healed progressively with healthy granulation tissue and marked reduction in wound size. Limb salvage was achieved despite the patient’s impaired healing capacity associated with diabetes and chronic hemodialysis.

This case demonstrates that even extensive leg ulcers in high-risk hemodialysis patients can heal successfully when meticulous surgical debridement is combined with appropriate wound care and compression therapy.