Debridement of necrotic eschar with 40% urea paste speeds healing of residual limbs and avoids further surgery.

A 50-year-old man with diabetes (patient 1) underwent left below-knee amputation (BKA) for a nonhealing infected foot ulcer. Necrotic eschars developed on the residual limb (Figure 1). He was referred to the dermatology department postoperatively for wound care prior to a planned above-knee amputation (AKA). A 62-year-old man with diabetes (patient 2) underwent bilateral BKA for gangrene secondary to foot ulcerations. One month postoperatively he was referred to the dermatology department for wound care of necrotic eschars involving both distal residual limbs. A 56-year-old man (patient 3) with diabetic neuropathy affecting both upper and lower extremities developed cellulitis and gangrene following thermal burns to the left sole. One month following BKA, the wound dehisced, and an adherent necrotic eschar formed at the distal residual limb. A 62-year-old woman with diabetes (patient 4) with ischemic gangrene of the left toes underwent BKA. After amputation, her residual limb developed ischemic necrosis with painful adherent eschar formation.