Problem Wound Management
Wagner Classifications and Associated Pathogens
| GRADE | |
| Zero | Monitor for Improvement |
| One | 4 to 8 weeks failure to heal. Refer to wound specialist |
| Two | Refer to Wound Specialist |
| Three | Refer to Wound Specialist |
| Four | Refer to Wound Specialist |
| Five | Refer to Wound Specialist |
| GRADE | DEFINITION |
| Zero | No ulcer |
| One | Superficial skin ulcer |
| Two | Deep ulcer extending through dermis. Tendon, ligaments, joint capsule or bone may be exposed |
| Three | Deep ulcer with abscess, osteomyelitis or joint sepsis |
| Four | Localized gangrene--forefoot or heel |
| Five | Gangrene of the foot |
TYPICAL PATHOGENS
"Normal" skin flora
Predominantly gram-positives, (Streptococcus, the Staphylococcus, Enterococcus spps.) lesser numbers of aerobic gram negatives and anaerobes. Bacterial population is more homogenous.
Polymicrobial (gram-positive, gram-negative and anaerobic) infections with increased number of the latter two species. Bacterial population is more heterogeneous.
