Ulcer Classification and Management

Fundamental Principles

The International journal of oral science recommends ulcers be classified based on anatomical location, etiology, and severity grading using validated systems, such as SINBAD for diabetic foot ulcers and clinical descriptors for oral ulcers 1, 2
Traumatic ulcers are caused by mechanical, physical, or chemical factors, according to the International journal of oral science 1, 2
Infectious ulcers have bacterial, fungal, or viral origins, as noted by Praxis Medical Insights 3
Vascular ulcers are related to ischemia or venous insufficiency, as stated in Diabetes/Metabolism Research and Reviews 4
Neuropathic ulcers are secondary to loss of protective sensation, according to Diabetes/Metabolism Research and Reviews and Praxis Medical Insights 4, 5

The SINBAD classification system should be used as the primary system for communication between healthcare professionals managing diabetic foot ulcers, as recommended by Diabetes/Metabolism Research and Reviews 4, 6, 5
The SINBAD system grades six parameters: site, ischemia, neuropathy, bacterial infection, area, and depth, with each scored 0 or 1, as described in Diabetes/Metabolism Research and Reviews 4
The IDSA/IWGDF classification system should be used for characterizing infected foot ulcers, with grades ranging from 1 (uninfected) to 4 (severe infection with systemic inflammatory response), as recommended by Diabetes/Metabolism Research and Reviews and Praxis Medical Insights 6, 5

For ulcers persisting beyond 2 weeks or not responding to 1-2 weeks of treatment, proceed with systematic investigation, including first-line blood tests and second-line testing when indicated, as recommended by the International journal of oral science and Praxis Medical Insights 2, 1, 3
Biopsy is indicated for any ulcer persisting >2 weeks despite appropriate treatment, atypical clinical features, or suspicion of malignancy, as stated by the International journal of oral science and Praxis Medical Insights 2, 1, 3

In diabetic foot ulcers, classification must account for the frequent coexistence of multiple pathologies, including neuropathic, neuroischemic, and pure ischemic ulcers, as noted by Diabetes/Metabolism Research and Reviews and Praxis Medical Insights 4, 5
The American Diabetes Association is not mentioned in the article, however, the International journal of oral science and Diabetes/Metabolism Research and Reviews provide recommendations for the management of diabetic foot ulcers 1, 4