Diyabetik Ayak: Diyabetik Ayak Yaralarının Sınıflandırılması
Özet
Diyabetik ayak yaralarının gelişiminde ve prognozunda yaranın yeri, boyutu, derinliği, enfeksiyon, nöropati ve iskemi gibi birçok faktör etkilidir. Farklı merkezlerde rutin bakım sonuçlarını ve tedavi stratejilerini karşılaştırmak, prognostik tahminleri standartlaştırmak ve özel bakım gerektiren hastaları belirlemek amacıyla pratik sınıflama sistemleri kullanılmaktadır. Bu kapsamda en sık tercih edilen Meggitt-Wagner sınıflaması, cilt lezyonunun derinliği ile osteomiyelit veya gangren varlığına göre altı derece içerse de enfeksiyon ve iskemi yönünden yetersiz kalmaktadır. Teksas Üniversitesi sınıflama sistemi yaraları derinliğine göre derecelendirip ayrıca iskemi ve enfeksiyona göre evrelere ayırırken, ülser alanı ile nöropatiyi kapsamaz. S(AD)SAD ve bunun basitleştirilmiş hali olan SINBAD sınıflamaları; bölge, iskemi, nöropati, enfeksiyon, alan ve derinlik kriterlerini puanlayarak prognoz tahminine katkı sunar. Uluslararası Diyabetik Ayak Konsensusu (PEDIS) ise nöropati ve periferik damar hastalığı riski hakkında bilgi vererek perfüzyon, boyut, derinlik, enfeksiyon ve duyu olmak üzere beş klinik kategoride değerlendirme yapar. Bunların yanı sıra CHS, DEPA, DUSS, DIAFORA, Van Acker/Peter, King'in, Kobe ve Amit Jain sınıflama sistemleri de yaranın süresi, maliyeti, iyileşme olasılığı ile etnik veya bölgesel özellikleri dikkate alan farklı bileşen ve puanlamalarla tedavi süreçlerine karar verilmesinde, prognoz öngörüsünde ve standart veri toplanmasında klinik çalışmalara rehberlik etmektedir.
Many factors such as wound location, size, depth, infection, neuropathy, and ischemia are effective in the development and prognosis of diabetic foot wounds. Practical classification systems are used to compare routine care outcomes and treatment strategies across different centers, standardize prognostic predictions, and identify patients requiring special care. In this context, the most frequently preferred Meggitt-Wagner classification includes six grades based on the depth of the skin lesion and the presence of osteomyelitis or gangrene, yet it falls short in terms of infection and ischemia. While the University of Texas classification system grades wounds by depth and stages them according to ischemia and infection, it excludes ulcer area and neuropathy. The S(AD)SAD and its simplified version, the SINBAD classification, contribute to prognostic prediction by scoring criteria such as site, ischemia, neuropathy, infection, area, and depth. The International Consensus on the Diabetic Foot (PEDIS) provides information on the risk of neuropathy and peripheral vascular disease, evaluating across five clinical categories: perfusion, size, depth, infection, and sensation. In addition, CHS, DEPA, DUSS, DIAFORA, Van Acker/Peter, King's, Kobe, and Amit Jain classification systems guide clinical studies in deciding treatment processes, predicting prognosis, and collecting standardized data through various components and scorings that consider wound duration, cost, healing probability, or ethnic and regional characteristics.
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