Evaluation of the WIfI classification system in older patients with diabetes

There are numerous factors that have an impact on diabetic foot ulcer (DFU) healing, among them critical limb ischaemia (CLI) — a term that was not intended to include patients with diabetic foot wounds and neuropathy. The Society for Vascular Surgery, therefore, created a new classification system for threatened lower extremities in which the severity of ulceration and severity of limb ischaemia are both graded. They also added a grade or classification scheme for infection.


The need to reconsider how the threatened limb is classified is clear. Ischaemia, while of fundamental importance, is but one component among a triad of major factors that place a limb at risk for amputation. The proposed Society for Vascular Surgery Lower Extremity Threatened Limb Classification System is based on grading each of the three major factors: Wound extent, degree of Ischaemia, and foot Infection, or WIfI (Mills et al, 2014). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging and complex heterogeneous population. During the 1990s, most DFUs were considered neuropathic (Armstrong et al, 2011). The Eurodiale Study, which included 1,229 patients presenting with a new DFU between September 2003 and October 2004, found non-plantar ulcers to be most frequent type of ulcers in this group …  read more