The skin is our protection from the environment. Far from being just a
physical barrier, the skin is a complex organ, protecting our bodies from
chemical, biological and physical insult, keeping organs and tissues in their
place, and regulating various secretions including sweat (to control
temperature), and pheromones (to act as sexual attractants). It is constantly
renewed and maintained. Injuries to the skin cause the potential for infection
and significant disruption to the healthy functioning of the tissues beneath.
Healing of the skin has been an essential pre-requisite for evolutionary and
individual survival, and complex biochemical systems have evolved for repair of
the skin.
Acute Wounds
Surgical wounds account for the vast majority of skin injuries. There are
almost 100 million surgical incisions every year which require some wound
management treatment. In approximately 80% of these cases, some form of
Wound closure product is used:
sutures,
staples,
and tapes. Many require
hemostasis (blood clotting) promoters, and of course the use of fabric
bandages and surgical dressings is almost universal.
Traumatic wounds occur at a rate of about 1.4 million cases every year.
Lacerations are a specific type of trauma wound that are generally minor in
nature and require only cleansing and dressing for a shorter period. Lacerations
occur frequently (approximately 19 million cases a year), as a result of cuts
and grazes. They can usually be treated in the doctor’s surgery, outpatient
medical center, or hospital accident and emergency department.
Burns
Burn wounds can be divided into minor burns, medically treated, and
hospitalized cases. Out- patient burn wounds are often treated at home, at the
doctor’s surgery, or at outpatient clinics. As a result a large number of these
wounds never enter the formal health service system. We estimate that
approximately 3.1 million burns in this category do enter the health service
system and receive some level of medical attention. These burns are mostly
treated using hydrogels and advanced wound care products, or even with consumer
based products for wound healing.
Medically treated burn wounds get more specialist levels of care to remove
heat from the tissue, maintain hydration, and prevent infection. Advanced wound
care products are used on these wounds. There are approximately 6.0 million
burns like this treated medically every year.
Hospitalized burn wounds are rarer and require more advanced and expensive
care. These victims require significant care, nutrition, debridement, tissue
grafting and often tissue engineering where available. They also require
significant nursing care and rehabilitation to mobilize new tissue, and
physiotherapy to address changes in physiology.
Chronic Wounds
Chronic wounds generally take longer to heal, and care required is enormously
variable, as is the healing time. There are approximately 5.2 million pressure
ulcers in the world that require treatment every year. Optimally, these wounds
receive advanced wound management products and appropriate care to address the
underlying defect that has caused the chronic wound.
Pressure ulcers are caused by compression of the skin and underlying
tissues, as when a patient is bedridden and the buttocks are pressed onto the
mattress; a number of advanced devices exist to reduce pressure for patients.
Other skin ulcers are caused by poor circulation, even without the added
complication of pressure. There are approximately 7.6 million
venous ulcers, and approximately 7.0
diabetic
ulcers in the world requiring treatment.
Chronic wounds are growing in incidence due to the growing numbers of elderly
individuals in the population, and the caseload is also increasing due to
improved diagnosis and education. At present these factors are contributing to
growth of this pool of patients faster than new technologies are reducing the
incidence of wounds by healing them.
Wound management techniques are also used for a number of other conditions
including amputations, carcinomas, melanomas, and other complicated skin
cancers, which are all on the increase.
Products Used in Advanced Wound Management
Dressings can be divided into categories using a number of different
classification systems. In
report #S245, “Worldwide Wound Management 2007-2016,” we focus our product,
marketing, and technology review on the category known as Advanced Wound
Management. This includes Film dressings, Hydrocolloids, Foam Dressings,
Alginate Dressings, Hydrogels, Non-Adherent Dressings, Antimicrobial dressings,
Cleansing and debridement products, Tissue engineered products, Pharmacological
products, (including Pain control, Antibiotics, Growth Factors, Non-Growth
Factor Modulators, Gene Therapy, and Scarring Modulators), Physical treatments
(like pressure devices, hydrotherapy, electrical stimulation, electromagnetic
stimulation, ultraviolet therapy, hyperbaric oxygen therapy, mechanically
assisted wound closure devices, ultrasound, laser and information systems. Some
of these product categories are well established; others are in development.