What does a Wagner Grade 4 Look Like?

Wagner Grade 4 diabetic foot ulcers involve localized gangrene of the toe, forefoot, or multiple toes. The gangrene may be either wet (characterized by swelling, infection, and discharge) or dry (mummified, black tissue without overt signs of infection).

Regardless of type, Grade 4 ulcers signify a critical threat to limb viability. Early recognition and prompt intervention are essential to prevent further progression. At this stage, surgical debridement or partial amputation is often necessary to remove necrotic tissue and halt the spread of infection.

Risk factors for developing Wagner Grade 4 ulcers include prolonged uncontrolled diabetes, peripheral arterial disease, neuropathy, and delayed treatment of lower-stage wounds.

Treatment protocols may involve advanced wound care techniques, vascular intervention to restore blood flow, and infection management with broad-spectrum antibiotics. In select cases, adjunctive therapies such as hyperbaric oxygen therapy (HBOT) may be considered to support healing following surgical intervention.

The following images provide real-life examples to help medical professionals, caregivers, and patients recognize this advanced stage of ulceration and emphasize the urgent need for specialized care.

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