I was just chatting yesterday with my friend and colleague, reconstructive surgeon Hiroto Terashi from Kobe, Japan. He turned me on to a system of his (Terashi, Kitano, Tsuji, 2010) that essentially completely eliminates depth as a variable. In other words, it is identical to, say, the University of Texas classification system (Armstrong, Lavery, Harkless, Diabetes Care, 1998), but simply classifies diabetic foot wounds as:
Type 1: purely neuropathic
Type 2: primarily ischemic
Type 3: primarily infected
Type 4: both infected and ischemic.
It got me thinking a bit about depth. How important is it, really? Does it just complicate things in description? For those of you who are interested, I'd love to hear from you as always.
Certainly, one can argue that, conceptually, the presence of ischemia or infection is more important than the presence of tendon or bone when one is initially planning therapy and predicting outcome, yes?
Citation: (Terashi, Kitano, Tsuji: Keio J Med 60 (1) : 17-21, March 2011)