[Clinical classification of diabetic foot as a guideline for selection of treatment]

Foot ulceration in patients with diabetes mellitus is always a serious risk factor for lower limb amputation. To amputate or to continue conservative treatment is usually a very difficult decision and not without mistakes. The main objective of the study was assessment of the diabetic wound depth as a clinical guideline for decision-making of conservative or aggressive surgical treatment. Local foot ulceration and results of management of 62 diabetics were analysed. Lower leg amputations were performed in 40% of the patients. The foot wound was evaluated according to University of San Antonio or Wagner's scoring system. Conservative treatment resulted in failure in 19% of patients of grade I, 54% of grade II, 60% of grade III and 87% of grade IV according to Wagner's. Using the San Antonio classification there were 20% of amputations in grade I, 58% in grade II and 65% in grade III. Taking into account infection and peripheral vascular disease there were 37% of amputations in stage B, 41% in stage C and 80% in stage D. Data analysis of the study suggests better clinical usefulness of the San Antonio classification system in prognosis of limb salvage. There is high probability of failure in conservative treatment of diabetic foot lesion of grade II and III and in stage D according to University of San Antonio scoring system.