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Acta Vulnologica 2016 September;14(3):140-51


language: English, Italian

SACS 2.0: a proposal for the classification of peristomal skin disorders. Results of a multicenter observational study

Mario ANTONINI 1, Gaetano MILITELLO 2, Silvia MANFREDDA 3, Raimondo ARENA 4, Stefano VERALDI 5, Stefano GASPERINI 6

1 USL 11 Ospedale San Giuseppe, Empoli, Firenze, Italy; 2 USL 4 Ospedale Santo Stefano, Prato, Italy; 3 Rimini Ospedale Infermi, Rimini, Italy; 4 AO ARNAS Garibaldi, Catania, Italy; 5 Institute of Dermatology, University of Milan, Milan, Italy; 6 Medicals Advisor, Pisa, Italy


About eight years have passed since the publication of the SACS Classification, the use of which has proved to be essential in Italy, not only on account of the particular characteristics of this instrument but also and above all as it is a point of reference for debate and discussion and aims to facilitate an objective awareness of peristomal skin lesions. Many outpatient clinics have adopted it as an indispensable instrument for communication both in Europe and in the rest of the world and the SACS Classification has now become a part of consolidated everyday clinical practice. In light of the experience that has been acquired, a review of the instrument is proposed, which will also be able to take into account and classify lesions, albeit rare, which until now could not fall under the same classification. We have thus focused on the study and observation of lesions that are unclassifiable or which may be classified in a manner that cannot be reproduced with the SACS method, enrolling a significant number of patients with a view to proposing a new system that will integrate the newly-defined lesion (L5). As a tribute to the original name the new instrument has been called SACS 2.0. A systematic review of the international literature was carried out in order to identify articles illustrating work aimed at improving the SACS classification. Our search highlighted a total lack of studies regarding this subject and so, a few years after the publication of our study, we were convinced of the need to propose a new classification which would be an improvement with respect to the previous version. The inclusion of an additional descriptive clinical picture of a lesion such as L5 and the possibility to classify any lesion present in the peristomal quadrant makes the classification more precise for the health professional. The purpose of this study was the review of the original SACS Classification on Peristomal Skin Disorders aimed at achieving two main objectives: 1) completion of the Classification to include an additional level of severity (L5); 2) classification of all types of peristomal skin changes present, eliminating the notion of “most serious lesion”.

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