Approximately 110 million surgical and procedure-based wounds are created annually worldwide that offer potential for use of adjunctive surgical closure and securement products; approximately 36 million of these wounds are created during surgical procedures in the United States.
Although healing of all these wounds might be improved through use of adjunctive surgical closure and securement products, it is likely that increased usage of these products will be limited, on economic grounds, to a fraction of procedures. It is realistically estimated that 10%â€“15% of these procedures would benefit from increased use of newly developed adjunctive surgical closure and securement products. MedMarket Diligence has established criteria, based on interviews with clinicians, health care systems and manufacturers, for the potential use of adjunctive surgical closure and securement products in surgical procedures, as detailed in the table below.
|Growth Factor||Produced by||Currently Known Effects|
|Epidermal Growth Factor (EGF)||Platelets, macrophages||Stimulates fibroblasts to secrete collagenase to degrade the matrix during the remodeling phase. Stimulates keratinocyte and fibroblast proliferation. May reduce healing time when applied topically.|
|Transforming Growth Factor (TGF)||Platelets, macrophages, lymphocytes, hepatocytes||TGF-a: Mitogenic and chemotactic for keratinocytes and fibroblasts|
|TGF||Platelets, macrophages, lymphocytes, hepatocytes||TGF-b1 and TGF-b2: Promotes angiogenesis, up-regulates collagen production and inhibits degradation, promotes chemo attraction of inflammatory cells.|
|TGF||Platelets, macrophages, lymphocytes, hepatocytes||TGF-b3 (antagonist to TGF-b1 and b2): Has been found in high levels in fetal scarless wound healing and has promoted scarless healing in adults experimentally when TGF-b1 and TGF-b2 are suppressed.|
|Vascular Endothelial Growth Factor (VEGF)||Endothelial cells||Promotes angiogenesis in hypoxic tissues.|
|Fibroblast Growth Factor (FGF)||Macrophages, mast cells, T-lymphocytes||Promotes angiogenesis, granulation, and epithelialization via endothelial cell, fibroblast, and keratinocyte migration, respectively.|
|Platelet-Derived Growth Factor (PDGF)||Platelets, macrophages, and endothelial cells||Attracts macrophages and fibroblasts to zone of injury. Promotes collagen and proteoglycan synthesis.|
|Interleukins||Macrophages, keratinocytes, endothelial cells, lymphocytes, fibroblasts, osteoblasts, basophils, mast cells||IL-1: Proinflammatory, chemotactic for neutrophils, fibroblasts, and keratinocytes. Activates neutrophils|
|Interleukins||Macrophages, keratinocytes, endothelial cells, lymphocytes, fibroblasts, osteoblasts, basophils, mast cells||IL-4: Activates fibroblast differentiation. Induces collagen and proteoglycan synthesis.|
|Interleukins||Macrophages, keratinocytes, endothelial cells, lymphocytes, fibroblasts, osteoblasts, basophils, mast cells||IL-8: Chemotactic for neutrophils and fibroblasts.|
|Colony Stimulating Factors (CSF)||Stromal cells, fibroblasts, endothelial cells, lymphocytes||Granulocyte colony stimulating factor (G-CSF): Stimulates granulocyte proliferation.|
|CSF||Stromal cells, fibroblasts, endothelial cells, lymphocytes||Granulocyte Macrophage Colony Stimulating Factor (GM-CSF): Stimulates granulocyte and macrophage proliferation.|
|Keratinocyte growth factor||Fibroblasts||Stimulates keratinocyte migration, differentiation, and proliferation.|
Source:Â Report #S180.
The surgical procedures falling within each category, based on specific procedure attributes, are shown (relative values only here; actual values in report #S180) in this chart.
Source: Report #S180.