Ulcer And Infection Classification

Wagner Classification System
Developed for the dysvascular foot, this system divides foot ulcers into 6 categories based on the depth of the ulcer and the degree of tissue necrosis. This system has been criticized because it does not take infection severity, ischemia, or comorbid conditions into account.

University of Texas San Antonio System
This system is based on ulcer depth, ischemia, and infection. It uses 4 grades and can be modified based on ischemia, depth of infection, or both. It has been used in clinical trials.

Pedis Ulcer Classification: Infectious Diseases Society of America¹
Developed for research standardization, this classification system is based on factors of perfusion, extent/size, depth/tissue loss, infection, and sensation. It includes grades 1–4: 1 — no infection, 2 — infection of skin and subcutaneous tissue, 3 — extensive cellulitis or deep tissue involvement, and 4 — systemic involvement. The Infectious Diseases Society of America incorporates the PEDIS classification into its recommended risk stratification. This risk stratification includes descriptions of clinical manifestations and categorization of infection severity in order to guide care locations.

Limb Threatening and Non–Limb Threatening: American College of Foot and Ankle Surgeons Clinical Practice Guideline²
This is a double classification system that describes disease severity and also implies outcome. It is recommended by the American College of Foot and Ankle Surgeons. This simple system divides superficial infections (non–limb threatening) and deeper infections (limb threatening) and can be used to guide therapy location and empiric antimicrobial choices.

1. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. CID. 2004;39:885–910. Available at: http://www.idsociety.org/content.aspx?id=4430#dfi. Accessed July 17, 2009.
2. Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. 2006;45(Suppl):S1–S66. Available at: http://download.journals.elsevierhealth.com/pdfs/journals/1067-2516/PIIS1067251607600015.pdf. Accessed July 17, 2009.