Validation of a Diabetic Wound Classification System: The contribution of depth, infection, and ischemia to risk of amputation

Abstract

Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System.

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

“…The presence of PAD and infection in patients with diabetic foot ulcers are major factors contributing to clinical outcome in terms of healing rates, healing time and amputation [8]. Foot ulcers were therefore categorised into four stages according to presence or absence of infection and PAD (Table 1); these stages are similar to those of the University of Texas system [8].…”

“…Foot ulcers were therefore categorised into four stages according to presence or absence of infection and PAD (Table 1); these stages are similar to those of the University of Texas system [8]. Using this classification, healing rates of 90% in stage A, 89% in stage B, 69% in stage C and 36% in stage D were reported [13].…”

“…Thus, different presentations of foot ulcers can be encountered in clinical practice, and management strategies, outcome and resource utilisation are strongly influenced by characteristics of these, such as the presence of PAD, the presence of infection and, probably, the presence of comorbidity [1,7]. The number of large studies reporting on patient and ulcer characteristics is limited, but significant differences in the underlying pathologies and patient characteristics have been reported [1,[8][9][10]. These differences might be related to factors such as race and variation in demographics, but it is also likely that the characteristics of the local healthcare organisation will determine the type of patients that are reported on, owing to differences in referral.…”

“…In many centres, patients with neuropathic or mildly neuroischaemic ulcers are treated in foot clinics, while patients with severe ischaemia and deep foot infections are admitted to surgical wards. From several studies there emerges a 'classic' picture of a patient with a neuropathic ulcer on the plantar surface of the foot [1,8,11,12]; with optimal therapy >80% of these 'uncomplicated' ulcers can heal within 3 months [13][14][15]. One might therefore question whether some studies provide an image of diabetic foot disease that is biased towards the least complicated foot ulcers or a specific subset of patients.…”

Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait

“…Diabetic foot infection (DFI) reportedly occurs in 40.8–58% of DFU cases[5,7] and osteomyelitis in approximately 20% of DFU, with this figure increasing to over 60% in the presence of severe DFI [8]. Furthermore, PAD and DFI have been associated with some of the most adverse outcomes of DFU and can lead to major amputation [9]. …”