WIfI: A Common Language for Toe and Flow | News | APMA
WIfI: A Common Language for Toe and Flow

July 11, 2019

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The WIfI classification system for Wounds, Ischemia, and foot Infection was first published in 2014[i] with the goal of providing a more meaningful system for analyzing lower-extremity wound care outcomes in a patient population increasingly plagued by diabetes. Quite simply, according to Jeffrey Ross, DPM, MD, associate professor of surgery in the Division of Vascular Surgery and Endovascular Therapy at Baylor College of Medicine in Houston, WIfI allows every member of the wound care team to “speak the same language—whether podiatrists, vascular specialists, orthopedic surgeons, or plastic surgeons.”

Dr. Ross and his colleague Joseph Mills, MD, professor and chief of the Division of Vascular Surgery and Endovascular Therapy at Baylor, will present this morning’s breakfast symposium on WIfI and how it’s improving outcomes for patients with lower-extremity wounds.

Through his role as a member of the APMA Clinical Practice Advisory Committee, Dr. Ross championed WIfI as a topic for presentation at the Annual Scientific Meeting. “The Annual Meeting Committee and the Board of Trustees approved this topic because they recognized that we as a specialty need to adopt this system because of the relationships we are creating” with other specialties, Dr. Ross said.

“We’re working in tandem; many times we’re in the OR together. It’s called ‘Toe and Flow,’ a collaboration that is vital to limb preservation.”

Dr. Ross pointed to improved communication as a major benefit of the system. WIfI is repeatable and standardized, allowing any physician, whether in the same hospital or on the other side of the world, to use the same terminology to understand and document a patient’s wound, level of perfusion, and level of infection. That helps improve continuity of care and also helps the care team determine the appropriate course of treatment. “We look at the WIfI levels: Is the infection localized or more widespread? Is it bad enough that podiatry needs to do something immediately to get a cleaner wound and then if there’s ischemia, we can do an endovascular procedure to increase circulation? If WIfI says infection is level 3, we need to debride and irrigate the infectious tissue to reduce the bioburden and get a more pristine wound.”

The WIfI ischemia level is also carefully monitored throughout treatment. “We use the phrase ‘open today, occluded tomorrow,’” Dr. Ross said. “You have to be vigilant. We can deal with some re-occlusion, but we can’t deal with a complete blockage.”

Drs. Mills and Ross will walk attendees through the WIfI stratification system and how it can help a team predict how well the wound will respond to treatment. Ultimately, Dr. Ross said, attendees will walk away with a better understanding of a system that will help reduce hospital stays, decrease tissue loss, and save limbs.

The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)

Mills, Joseph L. et al.

Journal of Vascular Surgery, Volume 59, Issue 1, 220 - 234.e2


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