The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection.

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Presentation transcript:

The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI) Joseph L. Mills, MD, Michael S. Conte, MD, David G. Armstrong, DPM, MD, PhD, Frank B. Pomposelli, MD, Andres Schanzer, MD, Anton N. Sidawy, MD, MPH, George Andros, MD Journal of Vascular Surgery Volume 59, Issue 1, Pages 220-234.e2 (January 2014) DOI: 10.1016/j.jvs.2013.08.003 Copyright © 2014 The Authors Terms and Conditions

Fig Hemodynamics and probability of healing of a diabetic foot ulcer modified by Joseph Mills and George Andros. Adapted from: http://iwgdf.org/consensus/peripheral-arterial-disease-and-diabetes/ CA Andersen. Noninvasive assessment of lower extremity hemodynamics in individuals with diabetes mellitus. J Vasc Surg 2010;52(Suppl):76S-80S. Journal of Vascular Surgery 2014 59, 220-234.e2DOI: (10.1016/j.jvs.2013.08.003) Copyright © 2014 The Authors Terms and Conditions

Supplementary Fig 1 (online only) Estimated 1-year amputation risk (%) by Society for Vascular Surgery (SVS) threatened limb clinical stage. Journal of Vascular Surgery 2014 59, 220-234.e2DOI: (10.1016/j.jvs.2013.08.003) Copyright © 2014 The Authors Terms and Conditions

Supplementary Fig 2 (online only) Clinical examples of Society for Vascular Surgery Lower Extremity Threatened Limb (SVS WIfI) classification system. A, W 1 – shallow neuroischemic ulcer. B, W 1 – shallow neuroischemic mal perforans ulcer over first metatarsal head. C, W 2 – deep lateral ankle ulcer with exposed tendon. D, W 2 – deep ulcer with exposed bone and tendon after debridement and control of infection. E, W 2 – digital gangrene (salvaged with revascularization and great toe amputation). F, W 2 – forefoot wound classified after debridement and control of infection. G, Successful transmetatarsal amputation after control of infection and tibial bypass (same patient as F). H, W 3 – gangrene into midfoot, ultimately salvaged with dorsalis pedis bypass and modified transmetatarsal amputation. I, W 3 – complex, deep, full-thickness heel ulcer. J, W 3 – complex heel ulcer, prior to debridement. K, W 3 – intraoperative view during debridement (same patient as J). L, Clinical stage 5 – unsalvageable extremity, W 3, and fI 3 with systemic inflammatory response syndrome. Journal of Vascular Surgery 2014 59, 220-234.e2DOI: (10.1016/j.jvs.2013.08.003) Copyright © 2014 The Authors Terms and Conditions