Wagner's Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital

Shah, Priti A.; Inturi, Ramteja; Anne, Dinesh; Jadhav, Digvijay; Viswambharan, Varsha; Khadilkar, Reina; Dnyanmote, Anuradha; Shahi, Shivangi

doi:10.7759/cureus.21501

Cited by 30 publications

(46 citation statements)

References 17 publications

(18 reference statements)

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“…Therefore, stratification of DFU patients and individualised treatment based on their Wagner's grade can reduce amputation rates and mortality. 19 Patients with delayed ulcer healing and larger ulcer lesions are at an increased risk for multidrug-resistant bacterial infections, as indicated by our findings, which corroborate those of previous research. It was hypothesised that as duration of DFU increases, so does the Wagner grade, leading to a rise in severe and mixed wound infections.…”

Section: Comparative Analysis Of Wagner Grades In Diabetic Foot Patientssupporting

confidence: 92%

Analysis of risk factors of infection in diabetic foot patients

Hsu,

Li,

Poon

2023

International Wound Journal

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This cross‐sectional study assessed the risk factors for infection in 150 diabetic foot patients admitted to the Xiamen University Hospital between October 2020 and October 2022. Patients were categorised as infected (n = 80) or uninfected (n = 70) cohorts. The diabetic foot was evaluated using the American Diabetic Foot Grading system, whereas ulcers were categorised using Wagner's method. Analysed were patient‐specific information, clinical data and risk factors including neuropathy, arterial disease and foot deformities. Our findings revealed no statistically significant differences between infected and uninfected cohorts concerning age, body mass index, gender, duration of diabetes or ankle‐brachial index values (p > 0.05). However, infected group had a higher proportion of smokers and reduced socio‐economic status (p < 0.05). Wagner grades indicated a greater severity in the infected group, with grade 3, grade 4 and grade 5 differing significantly (p < 0.05). Comparative analysis of ulcer characteristics revealed no statistically significant differences in ulcer surface area and depth, but the infected group had a higher prevalence of osteomyelitis and a greater number of ulcers (p > 0.05). Blood vessel complications, retinopathy, the presence of three or more ulcers, osteomyelitis and diabetic nephropathy were substantially more prevalent in the infected group, as determined by univariate analysis (p < 0.05). Subsequent multivariate logistic analysis revealed that patients with blood vessel complications, retinopathy, osteomyelitis, diabetic nephropathy and three or more ulcers were at increased risk for infection (p < 0.05). In addition, lifestyle factors, such as smoking, sedentary behaviour, inadequate foot hygiene, obesity and poor glycaemic control, were also associated with higher infection rates. A multivariate analysis of foot wound factors revealed that deeper, longer and recurrent lesions increased the likelihood of infection. Escherichia coli was the most frequently isolated bacterium from the infected group's bacterial culture, followed by Pseudomonas aeruginosa and Staphylococcus aureus. The study enhanced our comprehension of the multifactorial risk factors associated with infections in diabetic foot patients, highlighting the need for thorough clinical evaluation, lifestyle modification and vigilant infection control.

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Section: Comparative Analysis Of Wagner Grades In Diabetic Foot Patientssupporting

confidence: 92%

Analysis of risk factors of infection in diabetic foot patients

Hsu,

Li,

Poon

2023

International Wound Journal

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“…25 type 2 diabetes mellitus patients (19 males and 6 females) with DFU were recruited at our institution from July 2021 to May 2022. The inclusion and exclusion criteria are specified in Table 1, and only Wagner Classification [22] grades I to II were included in this study; Wagner grade I is superficial ulcer, and Wagner grade II is deep ulcer extending into the tendon, ligament, or bone, but no abscess. Patients with an ulcer of <2.5 cm in diameter on foot were included, [23,24] but patients with an ulcer area of lesser than 0.25 cm 2 were excluded.…”

Section: Study Subjectsmentioning

confidence: 99%

Application of extracorporeal shockwave therapy to improve microcirculation in diabetic foot ulcers: A prospective study

Jeong

Lee

et al. 2023

Medicine

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Extracorporeal shockwave therapy (ESWT) can induce wound healing by increasing tissue microcirculation. However, studies on the effect of ESWT on enhancing tissue microcirculation in diabetic foot ulcer (DFU), particularly on when the microcirculation increases after ESWT application, are still lacking. Therefore, we aimed to examine the effectiveness of ESWT in promoting microcirculation in DFU patients in a time-dependent manner. We included 50 feet of 25 patients with type 2 diabetes mellitus and Wagner grade I to II DFU in this study. The affected feet were used as the ESWT group and the unaffected contralateral feet were used as the control group. ESWT was performed in 3 sessions per week for a total of 3 weeks. Transcutaneous partial oxygen pressure (TcPO2) was used to evaluate the tissue microcirculation. The TcPO2 level (>43 mm Hg) in the ESWT group was recovered by the 2nd week of treatment, and statistical significance (P < .05) was demonstrated at the same time. From the 2nd week of ESWT, a significant increase in TcPO2 was observed in Wagner grade I and II DFU. These findings imply that the ESWT may improve microcirculation in patients with Wagner grades I to II DFU. However, this impact requires at least 2 weeks or more than 6 sessions. For better comparison, further studies with larger clinical groups and extended period are needed.

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“…All known diabetic patients with foot ulcers above 30 years of age with grade 1 (superficial, full-thickness ulcer limited to the dermis, not extending to the subcutis) and grade 2 (ulcers of the skin extending through the subcutis with exposed tendon or bone and without osteomyelitis or abscess formation) ulcers by Meggitt Wagner classification [ 12 ], and patients who were willing to take part in the study, were included in the study. Patients with grade 3 (deep ulcers with osteomyelitis or abscess formation), grade 4 (localized gangrene of toes to forefoot), and grade 5 (foot with extensive gangrene) ulcers by the Meggitt Wagner classification, patients with systemic diseases like ischemic heart disease, patients with venous ulcers, and critically ill patients were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

The Association of the Neutrophil-Lymphocyte Ratio With the Outcome of Diabetic Foot Ulcer

Sathvik¹,

Vuppuluri²,

Dulipala³

2023

Cureus

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IntroductionOne of the most common lower-extremity impediments in people suffering from diabetes mellitus (DM) is foot ulceration. Neutrophil-lymphocyte ratio (NLR) is a useful measure in predicting disease-specific morbidity and mortality. ObjectivesThe objective is to study the association between diabetic foot ulcer healing and the NLR. MethodologyA prospective analytical study was conducted among 100 patients with diabetic foot ulcers admitted to a surgical ward in a teaching hospital between April and November 2022. Basic demographic details, ulcer examination, and NLR were evaluated on the day of admission, and the status of ulcers was assessed after six weeks and the outcome was compared with the NLR value. Data analysis was done using SPSS version 20 software (SPSS, Inc., Chicago, IL). ResultsThe average neutrophils, lymphocytes, and neutrophil-lymphocyte ratio were, respectively, 94.73%, 14.97%, and 6.65%. 58% had healing ulcers, and 42% had non-healing ulcers. 44% of study subjects had NLR <6, which is normal, and 56% had NLR >6, which is abnormal. Among 58 subjects with healing ulcers, 75.9% had NLR < 6, and among 42 subjects with non-healing ulcers, 100% had NLR >6, which was statistically significant. The mean NLR in the healing group was 5.15 and in the non-healing group was 8.205; this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with a poor prognosis. ConclusionNLR can be used as a reliable indicator for determining the healing status of diabetic foot ulcers.

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Wagner's Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital

Cited by 30 publications

References 17 publications

Analysis of risk factors of infection in diabetic foot patients

Analysis of risk factors of infection in diabetic foot patients

Application of extracorporeal shockwave therapy to improve microcirculation in diabetic foot ulcers: A prospective study

The Association of the Neutrophil-Lymphocyte Ratio With the Outcome of Diabetic Foot Ulcer

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