“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.
C is for “Circulation to include arterial, venous and lymphatic circulation”
Defects in all three circulatory systems and lead to the formation chronic wounds. The arterial system, however, is the most important circulation system to assess when a patient presents with a lower extremity ulcer, because oxygenated blood is crucial to wound healing. Furthermore, the ischemic limb will deteriorate to dead tissue which will ultimately lead to amputation. Treatment involves vascular surgery to reperfuse the leg, followed by addressing the underlying cause of arterial insufficiency, for example, uncontrolled diabetes, atherosclerosis, etc.
The most common cause of lower leg extremity ulcers, however, is due to venous insufficiency. These wounds can be staged using the validated Clinical-Etiological-Anatomical-Pathophysiological (CEAP) scoring system which ranges from 0 to 6, with 6 being the most severe. Treatment of venous ulcers must include some form of passive or active compression therapy to facilitate the return of deoxygenated blood to the heart.
Lymphatic ulcers can develop from lymphatic insufficiency or secondary to venous insufficiency which then presents as a mixed etiology lymphatic ulcer. As a result, compression is also required for effective treatment. Lymphatic drainage as well as skin and nail care are additional treatment requirements. Fortunately, there are also at-home techniques that patients can use away from the clinic.
Click here to read more about A.B.C.E.S.S.
Stay tuned for next week’s topic! “E: Edema, and Exudate management”