Factors affecting wound healing and associated wound sealant and closure products

Medical and surgical wounds account for a huge share of healthcare dollars.   Managing these wounds, especially at the time of their formation (whether formed by trauma or surgical incision) now involves a comprehensive understanding of the nature of the wounds and the necessary process of their healing.  Manufacturers have developed a large arsenal of tools that can be used alone or in combination to accelerate and optimize wound healing.

The factors that determine whether, how long or how effectively wounds heal are detailed in the table below.

Factors Affecting Wound Healing

MoistureThe lack of sufficient moisture, or conversely an excess of moisture, can slow down repair. Lack of moisture often occurs with dry wound healing approaches; this stops cellularity, dries out cells and prevents the flow of humoral factors essential for removal of for pathogens and cell communication. It ultimately prevents the movement of keratinocytes for epithelialization. Too much moisture can lead to maceration, which causes osmotic damage to cells and slow healing, as well as breakdown of surrounding tissues.
InfectionInfection by micro-organisms can significantly slow down healing, leading to an extended inflammatory phase and cell necrosis. Some organisms in the wound are not detrimental, and evidence suggests that some microbes accelerate healing. However, organisms like Staphylococcus aureus and many anaerobic microbes are pathogenic and will live off the tissues.
DebrisThe presence of debris within the wound will delay healing. It is essential to remove any contaminating material that may be a source of infection, or which may delay healing through chemical or physical obstruction.
TemperatureTissue healing tends to be optimal at higher than normal physiological temperature. The exact reasons are not clear, but at higher temperatures enzymes and cell metabolism tend to achieve faster removal of pathogens and greater catabolic activity.
PressurePressure is a major extrinsic factor that can be detrimental to healing. This is why significant effort has gone into development of pressure relief products for use in situations involving mechanical stress. In addition, a number of devices have been evolved which are designed to modify the pressure around a wound to facilitate healing.

Source:  Report #S190

Traditional wound closure products have included sutures, tapes and, more recently, staples, clips and other “mechanical” wound closure.  These products have been augmented by the regulatory approval and marketing of fibrin (and other) sealants and glues, high-strength glues, hemostasis products and even products to prevent post-surgical adhesion (which often use sealant/glue analogues in a manner to prevent adhesion).

The market potential for the future utilization of surgical sealants, glues, wound closure and anti- adhesion products is closely tied to the growth in the number of procedures performed, as well as the gradual adoption of these products for multiple uses (sealing, hemostasis and even anti-adhesion.) Use of these technologies will eventually become routine in surgical and other clinical practices. Demographic forces are driving potential caseloads and therefore are also a factor in market potential. Changing regulatory demands will continue to influence the markets for these products, although this influence may drive demand up or cause a decrease in demand.

Below is illustrated the major product segments comprising the wound sealant and closure market worldwide, with growth and market size represented for each segment.

Source:  Report #S190