| Systemic Host- Compromising factors host (Medical and immune) |
| Age ≥ 80 yrs |
| Alcoholism |
| Chronic active dermatitis or cellulitis |
| Chronic indwelling catheter |
| Chronic malnutrition (albumin < 3.0gm/dl) |
| Current nicotine use (inhalational or oral) |
| Diabetes (requiring oral agents and/or insulin) |
| Hepatic insufficiency (cirrhosis) |
| Immunosuppressive drugs (e.g., methotrexate, prednisone, cyclosporine) |
| Malignancy (history of, or active) |
| Pulmonary insufficiency (room air arterial blood gas O2 < 60%) |
| Renal failure requiring dialysis |
| Systemic inflammatory disease (rheumatoid arthritis, systemic lupus erythematosus) |
| Systemic immune compromise from infection or disease (human immunodeficiency virus, acquired immunodeficiency virus) |
| Local Extremity Grade (wound) - Compromising factors |
| Active infection present > 3-4 months |
| Multiple incisions (creating skin bridges) |
| Soft tissue loss from prior trauma |
| Subcutaneous abscess >8 cm2 |
| Synovial cutaneous fistula |
| Prior periarticular fracture or trauma about joint (especially crush injury) |
| Prior local irradiation to wound area |
| Vascular insufficiency to an extremity: (absent extremity pulses, chronic venous stasis disease, calcific arterial disease) |
