Table 3.2.

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 soft tissue defect.

TMA, Transmetatarsal amputation.