A person wearing latex gloves wrapping up a wound on someone's arm or leg

The ABCESS System for Chronic Wound Management: S is for “Skin protection and treatment”

“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.

S is for “Skin protection and treatment including wound edge, periwound skin, and offloading management.”

Protecting healthy periwound skin from excess moisture is important to decrease the risk the four types of moisture-associated skin damage (MASD), including: 1) incontinence-associated dermatitis, 2) intertriginous dermatitis, 3) periwound skin damage, and 4) peristomal MASD. Wound fluid contains high levels of proteases which can break down healthy skin resulting in a bigger wound and increases risk of infection. Another challenge to healthy periwound skin is advanced age which leads to thin, brittle skin with reduced immune and vascular function. Fortunately, the LOWES classification for periwound dressings provides guidance on choosing dressings that help keep the periwound skin in-tact. It discusses the advantages and disadvantages of 1) liquid film-forming acrylates, 2) ointments, 3) windowed dressings with protective adhesive, and 4) external collection devices.

Making sure to keep the pressure off a wound is of utmost importance to prevent skin and soft tissue breakdown. In fact, pressure can independently create wounds, and for this reason, the risk stratifying Braden Scale was developed. This scale comprises the following six categories: sensory perception, moisture level, nutrition, mobility, friction and shear, and activity level of patient. Each category is scored from 1 to 4, and then tallied to give a final score between 6 and 23, where 6 indicates severe risk and 23 indicates mild risk of developing a pressure ulcer. To mitigate the risk of developing a pressure ulcer, there are 3 main types of cushioning devices available: 1) static devices, 2) low air-loss and or alternating pressure devices and 3) air fluidized devices. These can be in the form of offloading footwear, mattresses, and pillows.

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

Stay tuned for next week’s topic! “S: Social, societal, and spiritual factors, to include assessment of the immediate social environment, societal limiting factors, and personal issues affecting wound care.”