Improving wound care outcomes with ABPI: a clinical focus from Wounds UK

Wounds UK consistently highlights the importance of a holistic and evidence-based approach to wound care. Among the many factors influencing healing, accurate vascular assessment plays a key role – particularly in patients with leg ulcers, diabetic foot wounds, and other chronic lesions. One of the most valuable and recommended tools in this context is the ankle-brachial pressure index (ABPI), which allows clinicians to detect peripheral arterial disease (PAD), assess healing potential, and make informed treatment decisions.

Why is ABPI important in wound care?

PAD is estimated to affect more than 200 million people worldwide, with many cases remaining undiagnosed until complications arise. In wound care, undetected PAD can delay healing and increase the risk of limb-threatening infections. ABPI testing helps identify PAD early by comparing the systolic blood pressures at the ankle and the arm. An abnormal ABPI reading indicates compromised arterial flow – critical information for managing patients with chronic wounds.

According to the Best Practice Statement by Wounds UK, ABPI testing with pulse wave interpretation is a vital diagnostic tool that supports clinical decisions and improves patient outcomes.¹

When and whom to test?

Clinical guidelines recommend ABPI testing in patients with suspected PAD, non-healing wounds, or prior to initiating compression therapy. Populations at increased risk, such as people with diabetes, smokers, and older adults, should be prioritised for vascular assessment.

ABPI measurement should be part of the initial wound assessment and repeated when healing does not progress as expected. It provides an objective parameter to support diagnosis and is essential in distinguishing between venous, arterial, or mixed aetiologies.

Challenges with manual ABPI

Despite its clinical value, manual ABPI testing is underutilised. Traditional Doppler-based measurement requires time, training, and a second pair of hands. It is also prone to variability depending on operator skill and patient conditions. These barriers often lead to inconsistent or skipped assessments, leaving PAD undiagnosed.

Moreover, some clinicians avoid ABPI testing due to the perception that it is too time-consuming or complex to integrate into routine workflows – particularly in busy community or outpatient settings.

Clinical case

In podiatry, where wound care and vascular health are closely linked, ABPI testing plays an indispensable role. One case involved a 70-year-old diabetic patient presenting with a non-healing foot ulcer. Despite consistent debridement and dressing changes, healing stagnated. A quick ABPI measurement using an automated device revealed moderate PAD (ABPI 0.76), prompting a referral to a vascular specialist. The care plan was adapted, and with improved circulation support, the wound began healing within weeks.²

ABPI and compression therapy

One of the most significant applications of ABPI in wound care is guiding compression therapy. Applying high-pressure compression to a limb with undiagnosed PAD can cause ischemia and worsen the wound. Conversely, withholding compression due to uncertainty can slow healing in patients with primarily venous ulcers. Accurate ABPI results help clinicians determine the appropriate level of compression, balancing efficacy and safety. This improves patient comfort, enhances healing, and reduces the risk of complications.

The role of technology in streamlining ABPI measurement

Digital diagnostic systems are transforming how ABPI is measured. Automated devices reduce variability, eliminate the need for Doppler training, and provide results within minutes. This makes ABPI testing feasible in more settings – including primary care, wound clinics, and home visits.

Studies have shown that ABPI can now be performed in as little as one minute³ with the world’s fastest ABPI measurement available through innovative technology.⁴ This eliminates common barriers to vascular assessment and ensures that testing becomes a routine part of wound care workflows.

One such solution is the MESI mTABLET ABI, a digital diagnostic platform designed to improve the speed and accuracy of ABPI testing. It uses an automated, three-cuff method that allows for reliable and reproducible measurements, complete with pulse waveforms and smart interpretation. The system was developed in collaboration with wound care specialists, podiatrists, and vascular surgeons to meet the real-world needs of frontline clinicians.⁵

Accurate vascular assessment is critical in wound care. ABPI testing, though historically underused, is a cornerstone of effective diagnosis and treatment planning, particularly in patients with non-healing wounds. With the help of modern technology, clinicians can overcome traditional barriers and integrate ABPI measurement into routine workflows. Tools like ABPI not only improve diagnostic accuracy but also enhance patient safety, guide therapy, and accelerate healing. By adopting digital solutions such as the MESI mTABLET, healthcare professionals can ensure consistent, efficient, and evidence-based care for every patient.