Evolution of wound management technologies

During the 1970s the concept of moist wound healing was developed. Led by developments at Smith & Nephew, occlusive dressings were clinically tested and found to markedly improve wound healing rates over non-occlusive dry healing regimes. This moist wound healing approach came to be termed Advanced Wound Management, and led to the development of a wide range of products designed to maintain an optimally moist environment for accelerated wound healing.

Although occlusive dressings started the trend toward moist wound healing, many advanced dressing materials are not occlusive by nature. These dressings become moist by interaction with the wound bed; for example, alginate fibers that become gels. These products are used on highly exuding wounds during the phase in which they produce such high levels of exudates that they never dry out. In addition, dressings may be manufactured by treating one side of a foam dressing to create a semi-occlusive side, or advanced dressings can be used with secondary dressings that provide the semi-occlusive property. Advanced dressings may consist of more than one material to produce composite dressings that take advantage of the individual components and improve handling or delivery characteristics or provide a means of adhering the dressing to the skin around the wound.

Regardless of the type of dressing, manufacturers need to take an active role in developing educational material and dressing protocols as part of their value-added services. Purchasers also tend to place the burden of proof on manufacturers, demanding outcome studies on efficacy and cost-effectiveness before adopting new products or protocols.

In addition to controlling moisture produced by the wound, it is often valuable at the early debridement phase of treating chronic wounds, or at the late epithelialization phase, to add more moisture to the wound. This prevents desiccation at the later stages of healing, and can cause necrotic dead tissue to auto-debride by raising the hydration level at the necrosis surface. Autolytic debridement occurs under most of the advanced wound care products. Specifically, hydrogels such as IntraSite Gel (Smith & Nephew), Nu-Gel (Systagenix, formerly owned by Ethicon), Cutimed (BSD medical), and Urgo Hydrogel (Urgo) have been found to increase auto-debridement in this context.

The concept of moist wound healing is particularly relevant for the healing of chronic wounds like diabetic ulcers, chronic venous ulcers, and pressure sores.

Developments in advanced wound management involved the design and production of new and sophisticated types of dressings using new materials like foams, polyurethane films with high moisture vapor transmissibility, and hydrocolloids, along with highly absorbent biomaterials like alginates. Often designs were protected by patents, which allowed proprietary positioning of the products within the market and supported premium pricing for these more expensive products. The products offered some cost-effectiveness benefit due to the better outcomes associated with their use; they healed wounds faster, and if their use involved some extra expense it could be proven clinically that these advanced wound care dressings offered best practice healing techniques.

From a commercial perspective, the introduction of advanced wound care products introduced a ten-fold premium into the price achievable over prices of general wound care products. Whereas general wound care dressings might cost 10 to 50 cents per dressing, advanced wound care products could command prices of 1 to 20 dollars per dressing. This created huge value and gave incentives to businesses to establish persuasive sales training and practitioner education programs. The number of companies offering these products also led to fierce competition to build share within the rapidly growing segment of the market.
It should be remembered that advanced wound care dressings tend not to require changing as often as traditional dressings. Thus a week’s treatment of a venous ulcer might involve daily dressing changes using a traditional regime, while a single hydrocolloid dressing could last for a whole week.

In recent years the unitary value of an individual dose of specific products has grown again in response to technological advances. Tissue engineered products like Dermagraft and Apligraf, and pharmacological products like Regranex, Santyl, and pharmaceutical antibiotics, can command prices of hundreds (thousands for tissue engineering) of dollars for a course of treatment.

Source: MedMarket Diligence Report #S247, "Worldwide Wound Management 2009."