Publication:

Evaluation of management of diabetic foot ulcers according to Wagner’s classification in a tertiary care hospital in Northern India

Background Diabetic foot ulcer (DFU) is among the most severe and disabling complications of diabetes mellitus and represents a major cause of hospitalization, morbidity, lower limb amputation, and mortality worldwide. The incidence of diabetic foot complications is increasing rapidly in developing countries such as India due to rising diabetes prevalence, poor glycemic control, delayed healthcare access, and lack of foot care awareness. Wagner’s classification remains one of the most practical and widely accepted systems for evaluating diabetic foot ulcers and guiding treatment strategies. Early diagnosis and stage-appropriate intervention are essential for reducing complications and improving limb salvage rates.

Methods This prospective observational study was conducted among 70 patients with diabetic foot ulcers admitted to the Department of General Surgery in a tertiary care hospital in Northern India over a period of 18 months. Detailed demographic data, duration of diabetes, associated comorbidities, glycaemic status, ulcer characteristics, microbiological profile, and radiological findings were recorded. Ulcers were graded according to Wagner’s classification system. Patients received medical and surgical management including glycaemic control, antibiotics, debridement, incision and drainage, skin grafting, and amputations where indicated. Outcomes were evaluated in terms of ulcer healing, duration of hospital stay, and amputation rates.

Results The majority of patients were males (68.6%) with a mean age of 56.8±10.4 years. Wagner Grade II ulcers were most common (34.3%), followed by Grade III ulcers (28.6%). Peripheral neuropathy was observed in 71.4% of patients and poor glycemic control in 74.3%. Surgical intervention was required in 61.4% cases, with debridement being the most commonly performed procedure. Major amputations were more common in Wagner Grade IV and V ulcers. Increasing Wagner grade showed significant association with prolonged hospitalization and increased amputation rates (p<0.05).

Conclusions Wagner’s classification is an effective and reliable tool for assessing severity and guiding management of diabetic foot ulcers. Early diagnosis, strict glycemic control, aggressive infection management, regular wound care, and timely surgical intervention are essential to improve outcomes and reduce limb loss.