Diagnosis
6
Table 1. Wound grading in Wound, Ischemia, and foot
Infection (WIfI) classification
Grade Ulcer Gangrene
0 No ulcer No gangrene
Clinical description: ischemic rest pain (requires typical symptoms + ischemia grade 3);
no wound.
1 Small, shallow ulcer on distal leg or
foot; no exposed bone, unless limited
to distal phalanx
No gangrene
Clinical description: minor tissue loss. Salvageable with simple digital amputation
(1 or 2 digits) or skin coverage.
2 Deeper ulcer with exposed bone,
joint, or tendon; generally not
involving the heel; shallow heel ulcer,
without calcaneal involvement
Gangrenous changes limited to digits
Clinical description: major tissue loss salvageable with multiple (≥3) digital
amputations or standard TMA ± skin coverage.
3 Extensive, deep ulcer involving
forefoot and/or midfoot; deep,
full-thickness heel ulcer ± calcaneal
involvement
Extensive gangrene involving
forefoot and/or midfoot; full-
thickness heel necrosis ± calcaneal
involvement
Clinical description: extensive tissue loss salvageable only with a complex foot
reconstruction (nontraditional transmetatarsal, Chopart, or Lisfranc amputation);
flap coverage or complex wound management needed for large, so tissue defect.
Table 2. Ischemia grading in Wound, Ischemia, and foot
Infection (WIfI) classification
Grade ABI
Ankle systolic
pressure TP, TcPO2
0 ≥0.80 >100 mm Hg ≥60 mm Hg
1 0.6-0.79 70-100 mm Hg 40-59 mm Hg
2 0.4-0.59 50-70 mm Hg 30-39 mm Hg
3 ≤0.39 <50 mm Hg <30 mm Hg
