The ABCESS System for Chronic Wound Management: A New Acronym for Lower Extremity Wound Management

The authors propose a new acronym to promote teaching and learning evidence-based care for wounds of the lower extremity, maximizing healing potential, and assuring the ability to adapt to everchanging new technologies. ABCESS is a comprehensive framework for the assessment of a patient with a lower extremity wound. Wound care clinicians benefit from a system that is broad enough to include new guidelines and technologies as they appear. The TIME/DIME model has been used for many years to assist clinicians in thorough wound bed management. In order to expand the model to be able to address all aspects of lower extremity wound healing, ABCESS was developed. TIME has recently also been expanded to TIMERS in an attempt to address this. The ABCESS acronym was originally developed at the Temple University School of Podiatric Medicine to use as a teaching tool and organizational aid for students of wound healing. Each letter was used as a framework to aid the wound care clinician in performing a complete assessment of the patient with chronic wounds of the lower extremity: All of the patient, including a complete history, physical assessment, and systemic disease overview (with nutrition) to assess the physical aspects of the patient presenting with a wound; wound Bed management to include Bioload, Biofilm, cellular assessment of Biomarkers using polymerase chain reaction/DNA analysis, and wound Biopsy; Circulation to include arterial, venous, and lymphatic circulation; Edema, Exudate, and Erythema management focusing on dressing and compression choices; Skin protection and treatment to include wound edge, periwound skin, and offloading management; Social, Societal, and Spiritual factors, including assessment of the immediate social environment, the wider societal limiting factors, and personal, spiritual, and psychological issues affecting this patient's wound care.