The authors aimed to evaluate the efficacy of an advanced wound matrix (Integra Flowable Wound Matrix, Integra Life Science Corp, Plainsboro, NJ, USA) for treating wounds with irregular geometries versus a wet dressing in sixty patients with diabetic foot ulcers (Grades 3 Wagner ulcer). A randomized clinical trial was conducted in the General Surgery Unit and Geriatric of the Second University of Naples, Italy, in the last 12 months. Forty-seven cases of diabetic foot ulcers were equally and randomly divided into two groups: in a group treated with a wet dressing and expected closure by secondary intention; in another group the lesions were filled with Integra Flowable Wound Matrix and surgical wound edges were either approximated with stitches. The complete healing rate valued at 6 weeks, in the whole study population was 69.56% (Integra Flowable Wound Matrix group, 86.95%, control group, 52.17%; P=0.001). Amputation and re-hospitalization rates were higher in the control group compared to Integra Flowable Wound Matrix group. Therefore, the difference was statistically significant.This new porous matrix, allows a closure for the first intention of the lesion by reducing healing time and the demolition surgery. An advanced wound matrix is not associated with side effects, is well tolerated. Ease of use, absence of adverse effects, and a minimal invasive approach by primary intention closure of the lesion, make it appropriate in the management diabetic foot ulcers.Keywords: Diabetic foot ulcers; Tunneling lesions; Biomaterial; Flowable matrix Short CommentaryPatients with diabetes can develop many different foot complications. Even ordinary injures can get worse and lead to serious complications. Without early and optimal intervention, the wound can rapidly deteriorate, leading to amputation of the affected limb. A diabetic foot ulcer is a critical event in the life of a person with diabetes and is one of the complications of diabetes that can cause life threatening. Diabetic foot ulcers have a major economic impact as well; data have shown diabetic foot ulcers (DFUs) are a major cause of hospitalization for patients with diabetes.