A person's legs from the knees down. The leg on the left is normal and the one on the right is swollen badly.

The ABCESS System for Chronic Wound Management: E is for “Edema & Exudate Management”

“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.

E is for “Edema, and Exudate management”

Management of wound fluid is essential for successful wound healing. Both edema and exudate can be derived from the same mechanism of inflammation-mediated protein-rich fluid release from vasodilated blood vessels. In the context of lower-extremity wounds, edema is internal fluid collection and can be treated with compression for venous return to the heart. Exudate, however, is fluid released from an open wound and can be treated depending on volume and stage of the wound.

Wound exudate volume can be measured by the amount of saturation on an absorbent dressing. A dry wound has no exudate, and a normal wound has up to 25% saturation. A moderately exudating wound saturates up to 75%, and highly exudating wound saturates between 75% and 100% or even oversaturate. Exudate color and odor are also indicative of healing progression. A healthy healing wound presents with an odorless, thin, clear to straw colored exudate. Whereas a deteriorating wound presents with an odorous thick yellow, gray, green exudate due to bacterial infiltration and or necrosis. At this stage, the wound exudate may also be red due to capillary break-down.

Wound exudate management includes choosing dressings that 1) maintain fluid balance and allows for gaseous exchange, 2) protect the wound bed from additional contamination and 3) does not cause trauma after removal. Additional tools to prevent wound deterioration include: 1) enzymatic debridement for biofilm removal, 2) collagen products for tissue formation and preservation, among many other functions, 3) antimicrobial dressings to reduce bioburden and 4) negative pressure wound therapy to actively remove exudate.

Click here to read more about A.B.C.E.S.S.

Stay tuned for next week’s topic! “S: Skin protection and treatment including wound edge, periwound skin, and offloading management.”