Recommendations | Grade | Level of evidence | Key references | |
---|---|---|---|---|
| ||||
6.6 | Use an integrated threatened limb classification system (such as WIfI) to stage all CLTI patients who are candidates for limb salvage. | 1 (Strong) | C (Low) | Cull,68 2014 Zhan,69 2015 Causey,70 2016 Darling,71 2016 Robinson,72 2017 |
6.7 | Perform urgent surgical drainage and debridement (including minor amputation if needed) and commence antibiotic treatment in all patients with suspected CLTI who present with deep space foot infection or wet gangrene. | Good practice statement | ||
6.8 | Repeat limb staging after surgical drainage, débridement, minor amputations, or correction of inflow disease (AI, common and deep femoral artery disease) and before the next major treatment decision. | Good practice statement | ||
6.9 | Do not perform revascularization in the absence of significant ischemia (WIfI ischemia grade 0), unless an isolated region of poor perfusion in conjunction with major tissue loss (eg, WIfI wound grade 2 or 3) can be effectively targeted and the wound progresses or fails to reduce in size by ≥50% within 4 weeks despite appropriate infection control, wound care, and offloading. | Good practice statement | ||
6.10 | Do not perform revascularization in very-low-risk limbs (eg, WIfI stage 1) unless the wound progresses or fails to reduce in size by ≥50% within 4 weeks despite appropriate infection control, wound care, and offloading. | 2 (Weak) | C (Low) | Sheehan,73 2003 Cardinal,74 2008 Lavery,75 2008 Snyder,76 2010 |
6.11 | Offer revascularization to all average-risk patients with advanced limb-threatening conditions (eg, WIfI stage 4) and significant perfusion deficits (eg, WIfI ischemia grades 2 and 3). | 1 (Strong) | C (Low) | Abu Dabrh,5 2015 |
6.12 | Consider revascularization for average-risk patients with intermediate limb threat (eg, WIfI stages 2 and 3) and significant perfusion deficits (eg, WIfI ischemia grades 2 and 3). | 2 (Weak) | C (Low) | Zhan,69 2015 Causey,70 2016 Darling,71 2016 Robinson,72 2017 |
6.13 | Consider revascularization in average-risk patients with advanced limb threat (eg, WIfI stage 4) and moderate ischemia (eg, WIfI ischemia grade 1). | 2 (Weak) | C (Low) | |
6.14 | Consider revascularization in average-risk patients with intermediate limb threat (eg, WIfI stages 2 and 3) and moderate ischemia (eg, WIfI ischemia grade 1) if the wound progresses or fails to reduce in size by ≥50% within 4 weeks despite appropriate infection control, wound care, and offloading. | 2 (Weak) | C (Low) |