4 classification of diabetic foot ulcers GradeO Grade 1 Grade 2 No ulcer ina high-risk foot Superficial ulcer involving the full skin thickness but not underlying tissues Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation Grade 3 Grade 4 Grede 5 Deep ulcer with cellulitis or abscess Localized gangrene Extensive gangrene involving the formation, often with osteomyelitis whole foot oe Managemont of Diabetic Foot Ulcers Basod on the Brodsky Depth-Ischomia Classification and the Wagner Classification ™* Giassitication Definition Treatment Deptn grade 0 (Wagner grade 0) Intact skin, but foot at isk Patient education, accommodative footwear, reguar examination | {Wagner grade 1) Superficial uiceration, net infected External pressure relet: total contact cast, ‘rélabricaled pneumatic brace, walking brace, ‘accommodative foctwear II (Wagner grado 2} Deep ulceration with exposed tendon Surgical débridament, wound care, pressure rebel ‘orjoints (= superficial infection) if uicer converts to Wagner grad 1, antibiotics (infected) IW (wagner grate 3) Deep ulceration with expasedibone, Surgical ddbridement, antibiotics, pressure elit if ‘deep infection (osteomyelitis), Ulcer converts to Wagner grade 1. Ray or partial orabscess, oot amputation may be required in refractory cases. Ischemia stage A Noischemia Observation 8 Ischemia without gangrene Vascular evaluation, possible revastularization {Wagner grade 4) Partial gangrene (loreloot) Vascular evaluation and reconstruction, local versus larger amputation (Wagner grase 5) Complete gangrene ‘Amputation, possible vascular reconstruction = inthe Brodsky dopth schema eaesiicason, each fot 6 assigned bom a numdc grado and aloved sioga Tho numb Govcrbes the physical ropes of te wound, and th lta inaicaies tho overall asada stati otha Toot. The depm-ieenamis eissiication slvciales tho complox Felatonship botwoen ulcer developer wcund hoaling polenta andthe wasculs ays. whe aso provi an aperaach Yo beabment Wagner ‘Fade is hase onthe presence of ulceration (grades 0 Fvcugh 3) or descent vascular (grades 4 ad 8)