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Article
April 1940

CLINICAL CLASSIFICATION OF LESIONS OF THE LOWER EXTREMITIES ASSOCIATED WITH DIABETESA GUIDE FOR OPERATION AND THE LEVEL OF AMPUTATION

Arch Surg. 1940;40(4):685-693. doi:10.1001/archsurg.1940.04080030103006
Abstract

Lesions of the lower extremities associated with diabetes can be classified by purely clinical methods. This classification can be used as a guide for operation and will indicate which lesions.

1. Can be treated conservatively

2. Require operation

3. Present urgent indications for treatment

4. May be incised safely

5. Will heal with amputation of the toe

6. Require amputation at the calf

7. Require amputation at the thigh

Until recently, all the lesions have been vaguely grouped under the term "diabetic gangrene." The first suggestion of classification was made by Root and McKittrick when they called attention to the fact that some lesions are vascular and some infectious. In the light of recent progress in the diagnosis of diseases of the peripheral vascular system and our own observations in many cases,1 we have elaborated a practical clinical routine of examination. From the application of this careful examination we

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