The Svs Wifi Classification Predicts Wound Healing Better Than Angiosome Directed Perfusion In Neuroischemic Diabetic Foot Wounds
M. Libby Weaver, MD, Joseph K. Canner, MHS, Caitlin W. Hicks, MD MS, Ronald L. Sherman, DPM, MBA, Kathryn F. Hines, PA-C, Nestoras Mathioudakis, MD, James H. Black, III, MD, Christopher J. Abularrage, MD.
Johns Hopkins Hospital, Baltimore, MD, USA.
Previous studies have shown conflicting results in the wound healing outcomes based on angiosome directed perfusion, but none have adjusted for wound characteristics. We have previously shown that the SVS-WIfI classification correlates with wound healing in neuroischemic diabetic foot wounds (DFU) treated by a multidisciplinary team. The aim of this study is to compare WIfi classification versus angiosome-directed perfusion as a predictor of wound healing in patients presenting with DFU and peripheral arterial disease (PAD). Methods:
We performed a retrospective review of a prospectively maintained database of all patients presenting to our multidisciplinary DFU clinic who underwent angiography for PAD between 7/2012 and 12/2016. An angiosome was considered directly perfused if the artery feeding the angiosome was revascularized or was completely patent. Wound healing time at 1 year was compared based on direct vs. indirect angiosome perfusion (overall and stratified by open vs. endovascular revascularization), and WIfI classification. Results:
Angiography was performed on 196 wounds in 90 patients with PAD (mean age 63±12 years, 61% male, 58% African American race). There were 28 WIfI stage I, 24 stage II, 49 stage 3, and 95 stage 4 wounds. Direct angiosome perfusion was achieved in 139 wounds and indirect perfusion in 57 wounds. Direct angiosome perfusion was not associated with wound healing at 1 year (67 vs. 47%, P=.76). When stratifying groups into open and endovascular revascularization, there was a trend towards improved wound healing after open surgical direct perfusion (75 vs. 33%, P=.37) but no significant difference after endovascular intervention (67 vs. 58%, P=.88). Conversely, WIfI stage was the only statistically significant predictor of wound healing at one year, with more severely classified wounds demonstrating a lower probability of wound healing at one year (Stage 1: 93% vs. Stage 4: 63%, P<0.0001). Conclusions:
In the first study to stratify angiosome perfusion outcomes based on wound characteristics, we found that WIfI staging was a stronger predictor of neuroischemic diabetic foot wound healing than direct angiosome perfusion. This suggests that the ability to directly perfuse an angiosome should not be considered a prerequisite for limb salvage.
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