Role of Wound, Ischemia, and Foot Infection Scores in Predicting Major Limb Loss Despite Appropriate Revascularization

Abstract

Background: Wound, Ischemia, and foot Infection (WIfI) scores correlate well with amputation risk in patients with peripheral vascular disease. A certain subset will eventually require a major amputation despite revascularization. These patients may be offered the option of an upfront primary amputation and early rehabilitation. We sought to assess the WIfI staging and the novel WIfI composite scoring in identifying this subgroup. Patients and Methods: Patients with lower limb peripheral vascular disease with chronic lower limb extremity wounds who underwent revascularization procedures with the intent of limb salvage were included. Retrospective data of prospectively maintained preoperative WIfI scores, details of vascular intervention and occurrence of major amputation over 1 year from April 2018 to March 2019 was collected. Follow-up data were obtained for 1 year postoperatively. Results: Hundred thirty-seven patients were included. One hundred and one underwent an endovascular procedure, 17 underwent an aortobifemoral bypass, 16 underwent an open bypass procedure, and 3 were hybrid procedures. About 16.5% (23 patients) required a major amputation despite revascularization within 6 months of intervention. The mean total component score (out of 9) in these patients who required amputation was significantly higher (7.73 vs. 5.15, P < 0.05). Higher infection score preoperatively (2.17 vs. 0.88, P < 0.05) and higher wound score (2.7 vs. 1.63, P < 0.05) were significant. Mean ischemia scores were not significantly different between the two groups (2.87 vs. 2.65). The most common cause of amputation was infection (20 out of 23 events), and most of the amputations occurred in the first 1 month following. Three patients died within the 1-year follow-up period. Conclusion: Patients with higher total WIfI scores >7, higher wound, and infection components at presentation may have poor outcomes following revascularization.