A Guide To Understanding The Various Wound Classification Systems

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Here is a non-infected, non-ischemic heel ulceration in a patient with diabetic neuropathy. Dr. Satterfield notes that the Wagner wound classification does not take the presence of diabetic neuropathy into account. (Photo courtesy of Jonathan Moore, DPM)
A 72-year-old male presented with a wound that had recently developed on his right great toe. His physician had been managing the wound until it developed a large eschar and infection with drainage. (Photo courtesy of Eric Espensen, DPM)
A Guide To Understanding The Various Wound Classification Systems
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Author(s): 
By Kathleen Satterfield, DPM
Although the DEPA Scoring System is a validated system, it involved a small number of patients and a relatively short follow-up period.1 Key Insights On The University Of Texas System The University of Texas Classification of Diabetic Foot Wounds is becoming an increasingly popular system and has been validated in locations other than its original source.6 This straightforward system grades wounds first with numbers 0 to 3 referring to depth: 0 (pre- or post-ulcer with epithelialization), 1 (superficial and not involving tendon, bone or capsule), 2 (ulcer penetrates through to tendon or capsule) and 3 (penetrating to bone or joint). A second classification tier, A to D, refers to other burdens on the wound. A indicates non-infected/non-ischemic, B indicates infection, C indicates ischemia and D indicates infection plus ischemia. Clinicians may also utilize a complementary system called the Foot Risk Classification System, which was also developed at the University of Texas.7 This system allows the clinician to place the wound in an algorithm, based on its classification, that will maximize healing potential. This system allows the clinician to treat the wound based on a proven protocol that was successful for treatment of ulcers. When explaining the University of Texas (UT) wound classification system to a visitor, one UT trainee said the system was akin to using a roadmap when you are trying to get to a destination. Without the roadmap, you do not know which road to take. You have stops and starts, take wrong turns and if you do get to your destination, in this case “healing,” it is by pure luck rather than by intention. Diabetic wound healing is a complicated process that requires a definite plan based on scientific fact. A validated classification system can be the roadmap to get you there. Dr. Satterfield is a Clinical Associate Professor at the University of Texas Health Science Center at San Antonio. Dr. Steinberg (pictured) is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.

References:

References1. Younes NA, Albsoul AM. The DEPA scor ing system and its correlation with the healing rate or diabetic foot ulcers. The Journal of Foot and Ankle Surgery 43(3) July-August 2004.2. Wagner FW Jr. The diabetic foot. Orthopedics 1987; 10:163-72.3. Treece KA, Macfarlane RM, Pound N, Game FL & Jeffcoate WJ. Validation of a system of foot ulcer classification in diabetes mellitus. Diabetic Medicine 21(9), 987-991.4. Cuzzell JZ, The new RYB color code. American Journal of Nursing, 10, 1342-1346.5. Schaper NC. International ulcer classification for research purposes by the International Working Group on the Diabetic Foot. Proceedings of the 4th International Symposium on the Diabetic Foot. Diab Metab Res Rev. 1988. 6. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 1998 May; 21 (5): 681.7. Armstrong DG, Lavery LA, Harkless LB. Treatment-based classification system for assessment and care of diabetic feet. J Am Podiatr Med Assoc. 1996 Jul; 86(7):311-6.

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