Diabetic - Category D

Staging of diabetic wounds is not the appropriate way to describe a diabetic wound. Multiple methodologies for the description of diabetic wounds have been identified. AHS has chosen a descriptive approach reflective of the experience common to its clients.

Category D: Any diabetic ulcer with signs of significant infection or a deep ulcer exposing muscles, tendons, or bone; often associated with infection.

Note: an eschar covered ulcer cannot be categorized - reflecting at least a Category C ulcer, but could be a Category D or E ulcer.

Because the eschar may obscure underlying abscess formation, osteomyelitis or early gangrene, prompt physician notification and intervention is highly recommended

Examination of a Diabetic wound should report any signs of infection (redness, warmth, tenderness, and pus/drainage expressing from wound source).

Great care should be taken in evaluating callused areas on the feet of diabetic patients.

• Callused areas represent areas of increased risk for breakdown.
• Callused areas may also be covering areas of tissue injury underneath the callused area.
• Contact the patient's podiatrist for examination and/or removal of calluses.
• Signs of tissue injury underneath the callus.

In high-risk diabetic patients, daily observation of all foot surfaces is an essential component of diabetic management.

In order to appropriately establish wound type and etiology, a thorough wound assessment should be completed as required by state and federal guidelines.

This thorough initial wound assessment or wound reassessment (as a component of a wound status change) is described AHS’ Assessment Guideline. It requires a detailed assessment of the whole patient and their history as well as other factors including duration of the wound, patient’s recollection of the causative factors, complaints of pain, fever, numbness or drainage.