tailieunhanh - Tài liệu Diabeticcpg small 2 (Part 6)

Descriptors for these considerations (62, 290, 291). For example, the University of Texas San Antonio (UTSA) system (Table 6) associates lesion depth with both ischemia and infection (290). This system has been validated and is generally predictive of outcome, since increasing grade and stage of wounds are less likely to heal without revascularization or amputation (290, 293). The UTSA system is now widely used in many clinical trials and diabetic foot centers. Another hybrid system, the PEDIS system, evaluates five basic characteristics: perfusion, extent/size, depth/tissue loss, infection and sensation (294) (Table 7). While this system has yet to be validated,. | Wagner Classification System Table 5 Grade Lesion 0 No open lesions may have deformity or cellulitis 1 Superficial ulcer 2 Deep ulcer to tendon or joint capsule 3 Deep ulcer with abscess osteomyelitis or joint sepis 4 Local gangrene - forefoot or heel 5 Gangrene of entire foot descriptors for these considerations 62 290 291 . For example the University of Texas San Antonio UTSA system Table 6 associates lesion depth with both ischemia and infection 290 . This system has been validated and is generally predictive of outcome since increasing grade and stage of wounds are less likely to heal without revascularization or amputation 290 293 . The UTSA system is now widely used in many clinical trials and diabetic foot centers. Another hybrid system the PEDIS system evaluates five basic characteristics perfusion extent size depth tissue loss infection and sensation 294 Table 7 . While this system has yet to be validated it provides the benefit of having been developed by a consensus body. Imaging studies play an important role in the assessment and evaluation of the diabetic foot ulcer 179 180 183 197 . Plain x-rays are indicated based on the extent and nature of the ulcer. Clinical change in the appearance of the ulcer or failure to heal with appropriate treatment may dictate repeating the radiograph periodically to monitor for osseous involvement 30 . Additional imaging modalities such as nuclear medicine scans ultrasonography MRI and CT may be indicated depending on the clinical picture. These modalities have been previously discussed in this document. Figure 6 summarizes the important elements of the overall assessment of the patient with a diabetic foot ulcer. The assessment addresses underlying pathophysiology possible causal factors and significant predictors of outcome 25 49 54 100 272 . Treatment of Diabetic Ulcers Guiding Principles The primary treatment goal for diabetic foot ulcers is to obtain wound closure as expeditiously as possible. Resolving foot ulcers