“The ABCESS System for Chronic Wound Management: A New Acronym for Lower Extremity Wound Management.”
Healthy wound healing is complex. Wound healing with one or more co-morbidities is even more complex- but not impossible. In the past we were guided by T.I.M.E, and now it is time for A.B.C.E.S.S. Pioneered by Dr. James McGuire, DPM, PT of Temple University, we are equipped with a comprehensive methodology to address all variables of wound healing to generate positive outcomes for patients, that is, wounds that close- and stay closed.
B is for “Wound bed management: Bioload/Biofilm/Biopsy to include cellular and acellular tissue-based products to aid wound closure.”
After holistic assessment of the patient, identifying, and staging the wound is of utmost importance, followed by determining the presence or absence of infection, followed by the appropriate treatment. To identify and stage lower limb wounds, the wound, ischemia, foot infection (WIfI) classification system is helpful. Wound, ischemia, and foot Infection, are the 3 main factors for chronic wounds, and each category is labeled as 0 through 3, with 3 as most severe. A tally of these categories results in a score of 1 through 4, which is a measure to predict amputation risk, with 4 indicating the highest risk.
After this risk stratification, the step-down/step-up approach can be used to treat the wound until closure. This is defined by 4 distinct treatment periods: 1) initiating multiple therapies, 2) optimizing and personalizing therapy according to healing status, 3) de-escalating wound healing, followed by 4) standard wound care or stepping up to advanced therapies if the wound requires it.
To fight infection, evidence suggests that a biofilm-based wound care protocol using appropriate wound dressing options may be most effective because it accounts for both planktonic and biofilm-encased bacteria, thereby ensuring the reduction of wound bioburden.
Click here to read more about A.B.C.E.S.S.
Stay tuned for next week’s topic! “C: Circulation to include arterial, venous and lymphatic circulation”