1. Table II, the full system, is to be used for initial, baseline classification of all patients with ischemic rest pain or wounds within the spectrum of chronic lower limb ischemia when reporting outcomes, regardless of form of therapy. The system is not to be employed for patients with vasospastic and collagen vascular disease, vasculitis, Buerger's disease, acute limb ischemia, or acute trauma (mangled extremity).
  2. Patients with and without diabetes mellitus should be differentiated into separate categories for subsequent outcomes analysis.
    1. Presence of neuropathy (±) should be noted when possible in patients with diabetes in long-term studies of wound healing, ulcer recurrence, and amputation, since the presence of neuropathy (loss of protective sensation and motor neuropathic deformity) influences recurrence rate.
  3. In the Wound (W) classification, depth takes priority over size. Although we recommend that a wound, if present, be measured, a shallow, 8-cm2 ulcer with no exposed tendon or bone would be classified as grade 1.
    1. If a study of wound healing vs Wound (W) grade were performed, wounds would be classified by depth, and could also be categorized by size: small (<5 cm2), medium (5-10 cm2), and large (>10 cm2)
  4. TPs are preferred for classification of ischemia (I) in patients with diabetes mellitus, since ABI is often falsely elevated. TcPO2, SPP, and flat forefoot PVRs are also acceptable alternatives if TP is unavailable. All reports of outcomes with or without revascularization therapy require measurement and classification of baseline perfusion.
  5. In reporting the outcomes of revascularization procedures, patients should be restaged after control of infection, if present, and/or after any debridement, if performed, prior to revascularization (Table IV).
    1. Group a patients: no infection within 30 days, or simple infection controlled with antibiotics alone
    2. Group b patients: had infection that required incision and drainage or debridement/partial amputation to control

ABI, Ankle-brachial index; PVR, pulse volume recording; SPP, skin perfusion pressure; TcPO2, transcutaneous oximetry; TP, toe pressure.