Troubleshooting WIFI: An Extension to the Current Lower Extremity Threatened Classification System
Tanzim Khan, DPM, Anastasia Plotkin, MD, Laura Shin, DPM, PhD, Kenneth Ziegler, MD, Gregory Magee, MD, David Armstrong, DPM, MD, PhD, Vincent Rowe, MD.
Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
OBJECTIVES: The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System has been developed to stratify amputation risk on the basis of extent of the wound, level of ischemia, and severity of foot infection (WIfI). We propose an extension of WIfI to stratify patient function as an adjunct to patient assessment algorithm to guide clinician decision making. METHODS: With continued advancements in revascularization wound care, limb salvage has become paramount, necessitating interdisciplinary limb salvage teams. Efforts at limb salvage are based on the potential for improved functional outcome, offering treatment ranging from local wound care, partial foot amputations, vascular bypass, and when necessary, major limb amputation. With the availability of various treatment modalities, clinicians are tasked with deciding which is most appropriate based on risk stratification tools such as WIfi. However, as one of the primary goals of limb salvage, function is underrepresented in assessment for these cases. Therefore, we are proposing an extension to the current WIfI system, one that grades functional status following the 0-3 grading schematic in the current WIfI system. RESULTS: Following the 0-3 grading schematic in the current WIfI system, we propose a similar ordinal tool for documenting function. Ambulation outside the home with or without an assistive device equates to a grade 0, while grade 1 would represent a patient who solely ambulates at home. A grade 2 patient would use their limb for transfers, and grade 3 categorizes patients who are bedbound. Taking the patient’s preoperative functional status into consideration along with the other components of the WIfi system, may aid clinicians in deciding on the most appropriate management of this heterogeneous patient population. This extended WIFI score may be more predictive of improved functional status at follow-up and enable better postoperative expectations. CONCLUSIONS: Adding function as an assessment tool to guide clinical decision making is critical as it considers not only best outcomes, but also patient goals. This extension of WIFI will aid limb preservation teams in efficient, rapid, and collective clinical decision making to improve limb salvage efforts with a patient-centered focus and functional outcome goals
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