. 2022 Sep 1;15347346221122860.

doi: 10.1177/15347346221122860.

Online ahead of print.


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Virginie Blanchette et al.

Int J Low Extrem Wounds.



Nearly a decade ago, the Society for Vascular Surgery (SVS)’s wound, ischemia, and foot Infection (WIfI) classification was first developed to help assess overall limb threat. However, managing conditions such as diabetic foot ulcer and chronic limb-threatening ischemia can be complex. For instance, certain investigative findings might initially be pending such as the level of ischemia or extent of infection before the final classification is established. In addition, wounds evolve rapidly, and the current classification does not allow for tracking their progression over time during treatment. Therefore, we propose a supplemental consistent notation for scoring WifI re-assessment during treatment of a threatened limb inspired by the cancer staging before and after neoadjuvant treatment classification system. Thus, we describe the re-scoring system and how to use it. Our suggestion supports a coherent method to longitudinally communicate characteristics of a threatened limb. This has potential to support high quality interdisciplinary, patient-centered care and enhance the use of this classification in research. Further work is required to validate this modification of a common language of risk.


amputation; classification; diabetes; foot ulcer; ischemia; wound healing, peripheral vascular disease.

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Evolution of WIfI: Expansion of WIfI Notation After Intervention