The formation of a wound, whether by surgical incision, trauma, or disease, sets up a complex set of conditions that may variously result in rapid healing, a local or systemic infection, a decubitus ulcer or other chronic, non-healing wound. A range of factors can and will dictate which course will ensue, and it is the focus of medical product manufacturers to develop increasingly effective products for debridement, hemostasis, prevention of infection, wound closure, wound sealing, moist (but not too moist) environment, negative (or positive) pressure as necessary, control of temperature and other roles in wound management.
Below are illustrated the fundamental factors affecting wound healing.
Factors Affecting Wound Healing
|Moisture||The 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.|
|Infection||Infection 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.|
|Debris||The 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.|
|Temperature||Tissue 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.|
|Pressure||Pressure 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: MedMarket Diligence, LLC; Report #S190.
It is important to close a wound rapidly and to create a moist wound healing environment that is not disturbed by adverse temperature and other effects. The successful application of surgical closure and securement products can serve to accomplish this goal, maintaining the natural tissue continuity and integrity, and helping to control bodily temperatures within optimal healing conditions.
There are several new technologies, delivery systems and products in development, some of which may come onto the market during the forecast period or shortly thereafter. In parallel with the invention of new products, in several instances new delivery systems have had to be developed. For example, new delivery systems have evolved to spray liquid hemostat solutions such as thrombin onto surgical sites to improve speed of hemostasis. Fibrin sealant is supplied as two powders that need to be solubilized and then mixed immediately prior to application to the surgical site. This has led to the development of a number of sophisticated medical delivery devices, while some companies are developing single component systems that are already solubilized for immediate use in the surgical theater.