Causal Pathways for Incident Lower-Extremity Ulcers in Patients with Diabetes from Two Settings. Wound classification systems should be based on objective criteria, and measurements should be precise and clear. For clinical practice, in particular, they should be practical, easy to use and an important tool in clinical decision making. The key elements of a classification are size, infection, ischaemia and neuropathy. Some experts feel that associated risk factors should also be included.
Full testing is essential for evaluation for practical and scientific use.
The authors point out that the developed classification is 'not intended as a guide to management, but an aid to audit and research enabling certain types of ulcers to be identified for recruitment to prospective studies, as well as a means of comparing outcome between centres'. It is important to strive for consensus now. A classification of diabetic foot ulcers was not included because there was not enough clinical experience at that time. However, the board of the working group is now planning to organise an international conference with the experts in the field of classification systems to set a worldwide accepted general classification on diabetic foot ulcers for daily practice and clinical research. This should serve as part of an update on the second edition of The International Consensus and Practical Guidelines on the Diabetic Foot for 2003.