Management of complex diabetic foot wounds with large skin defects poses a challenge for surgeon. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 to October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm² (range: 4.71 -66.76 cm²).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 days to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm² per day, ranging from 0.29 cm² per day to 8.35 cm² per day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistically difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach for complex diabetic foot wounds. Nevertheless, more attentions should be paid for the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.