A higher initial Wound, ischemia, and foot infection (WIfI) classification score at initial presentation in chronic limb-threatening ischemia (CLTI) patients who underwent a transmetatarsal amputation (TMA) was not associated with a major amputation down the road, according to a retrospective review of 55 TMAs performed at the University of Washington (UW) in Seattle.
A research team at the institution sought to establish whether the Society for Vascular Surgery (SVS) lower-extremity threatened limb risk stratification system could predict successful healing following TMAs, ultimately determining it does not—with the data showing this included both the wound and ischemia score on presentation as well as after revascularization.
The study findings were revealed during the Society for Clinical Vascular Surgery (SCVS) annual symposium in Las Vegas (March 19–23). Despite the core conclusion, presenting author Jake Hemingway, MD, a vascular surgery resident at UW, told delegates: “We found that excellent wound healing can still be achieved despite very advanced CLTI and, thus, we shouldn’t use the WIfI stage alone to try and preclude patients from attempts at limb salvage. There still is a need for further investigation into how we can monitor our patients after undergoing a TMA to know when further work needs to be done to maintain that wound.”
The 51 patients included in the study saw a 12-month major amputation rate of 33%—12 carried out below the knee, and six above. Hemingway said the data demonstrated that an unsuccessful TMA was down to primary failure in 10 patients, “in which they simply never were able to heal their wound, as opposed to secondary failure, which was wound breakdown remote from their initial TMA.” Four patients saw TMA failure due to infection, developing either necrotizing infection or wet gangrene during their initial healing process, he added.
“When we looked at the factors that were actually associated with major amputation, we found that none of the following were: Either a higher initial WIfI stage wound or ischemia score at the initial presentation; or whether patients had improvement following revascularization—this was also not associated; neither was the ischemia score post-revascularization,” Hemingway said.
Hemingway revealed during questions after his presentation that the UW research team is set to enter a new phase of the study to look at other non-invasive, nonpressure-based measures such as pedal acceleration times in order to establish the most predictive system for successful healing after a TMA.
