Foot ulcerations are among the most complex and heterogeneous complications in patients with diabetes. Skin ulcers need to be managed in different ways dependent on their etiology and pathogenesis.
The 10 Saint Elian Wound Score System (SEWSS) categories is helpful in guiding treatment decisions based on severity subcategories.
SEWSS Checklist of 10 Wound Severity Factors for Score and Grading
Anatomical | Aggravating Factors | Affected Tissues |
Location (1-3) 1. Phalanges/digits 2. Metatarsal 3. Tarsal |
Ischemia (0-3) 0. No 1. Mild 2. Moderate 3. Severe |
Depth 1. Superficial (skin only) 2. Deep ulcer (below dermis) 3. All layers (bone and joint) |
Topographic aspects (1-3) 1. Dorsal or plantar 2. Lateral or medial 3. Two or more |
Infection (0-3) 0. No 1. Mild. Erythema <2 cm, induration, tenderness, warmth, and purulent discharge 2. Moderate. Erythema >2 cm, muscle, tendon, or bone or joint infection 3. Severe. systemic inflammatory response |
Area (1-3) 1. Small <10 cm2 2. Medium 10-40 cm2 3. Big >40 cm2 |
Affected zones (1-3) 1. One 2. Two 3. Entire foot (multiple wounds) |
Edema (0-3) 0. No 1. Periwound 2. Affected leg only 3. Bilateral secondary to systemic disease |
Wound healing phase (1-3) 1. Epithelialization 2. Granulating 3. Inflammatory |
Neuropathy (0-3) 0. No 1. Protective sensation or vibration diminished 2. Loss of protective sensation or vibration 3. Diabetic neuro-osteo artropathy-Charcot |
Score
Score Sum | Grade | Prognosis |
≤10 | I, mild | Likely successful wound healing |
11-20 | II, moderate | Partial foot-threatening; outcome related to “state-of-the-art” therapies used and associated with a good patient biological response |
21-30 | III, severe | Limb- and life-threatening; outcome unrelated to “state-of-the-art” therapies because of poor biological patient response |
References:
- Martínez-De Jesús FR. A checklist system to score healing progress of diabetic foot ulcers. Int J Low Extrem Wounds. 2010;9(2):74‐83. [Medline]
- Huang Y, Xie T, Cao Y, et al. Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems. Wound Repair Regen. 2015;23(3):379‐385. [Medline]
Created May 29, 2020.