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.
Grade | Ulcer Depth |
---|---|
0 | Skin intact, Pre-ulcerative area without open lesion |
1 | Superficial ulcer (partial/full thickness) |
2 | Deep Ulcer (extending to tendon, capsule, bone) |
3 | Stage 2 with abscess, osteomyelitis, or joint sepsis |
4 | Localized gangrene (involving some portion of the toe, toes, and/or forefoot) |
5 | Global foot gangrene |
- Aboyans, Victor et al. “2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS).” European heart journal vol. 39,9 (2018): 763-816. doi:10.1093/eurheartj/ehx0951996;348:1329–133
- Gerhard-Herman, Marie D et al. “2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Circulation vol. 135,12 (2017): e686-e725. doi:10.1161/CIR.0000000000000470