The Meggitt-Wagner system

The classification system introduced by Meggitt in 1976 and later popularized by Wagner in 1979 was once widely adopted. It operates on a six-grade scale, primarily assessing ulcer depth and tissue necrosis level. While this wound-centric system is straightforward and easy to apply, it lacks consideration for crucial clinical factors like peripheral neuropathy and peripheral arterial disease (PAD). As a result, it struggles to differentiate between infected and ischemic ulcers, leading to acknowledged imprecision and limitations.

GradeUlcer Depth
0Skin intact, Pre-ulcerative area without open lesion
1Superficial ulcer (partial/full thickness)
2Deep Ulcer (extending to tendon, capsule, bone)
3Stage 2 with abscess, osteomyelitis, or joint sepsis
4Localized gangrene (involving some portion of the toe, toes, and/or forefoot)
5Global foot gangrene
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