Some studies have shown an average reduction of 30% (range 13%–48%) in ulcer surface area using traditional therapy in patients with stage II through IV ulcers compared with a 62% (range 37%–84%) reduction in 4 to 8 weeks in patients treated with various adjuvant therapies (ie, electrical stimulation, topical nerve growth factor).11–14 Our patient had 3 stage III and IV wounds that failed to heal with many years of traditional therapy. This evidence concerns the gene NGF and ulcer disease.