Traditional and Advanced Wound Product Types

Wound management technologies have been under development for hundreds of years. The current state of product and technology development is now largely represented by thirteen different product categories described with their specific typical applications (1)Specific companies and products are detailed in “Wound Management to 2026”, report S254.

Wound Management Technologies By Type

Wound product categoryDescriptionPotential applicationsProduct and Manufacturer Examples
Traditional GauzeInexpensive, common, breathable, usually dries out the wound, may stick to wound causing damage when removedMay be used to secure a dressing in place, or directly over any wound type to keep it clean while allowing aeration.See link
Traditional AdherentDry, inexpensive, common, non-absorbent, will not stick to wound. Usually uses a wide mesh material with a finer mesh or foam, nonstick material.Applied directly to wound; used for large surface wounds such as abrasions or burns. Indicated when a good granulation bed has developed.

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Traditional Non-AdherentConforms to wound, keeps wound bed moist, will not stick to the surface of wound.Light to moderately exudative wounds, burns.

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FilmAvailable as adhesive, thin transparent polyurethane film, and as a dressing with a low adherent pad attached to the film.Clean, dry wounds, minimal exudate; also used to cover and secure underlying absorptive dressing, and on hard-to-bandage locations, such as heel.

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FoamPolyurethane foam dressing available in sheets or in cavity filling shapes. Some foam dressings have a semipermeable, waterproof layer as the outer layer of the dressingEnables a moist wound environment for healing. Used to clean granulating wounds with moderate to severe exudation.

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HydrogelColloids that consist of polymers that expand in water. Available in gels, sheets, hydrogel impregnated dressings.Provides moist wound environment to add moisture to dry wound, aids in cell migration, reduces pain, helps to rehydrate eschar. Used on dry, sloughy or necrotic wounds.

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HydrocolloidMade of hydroactive or hydrophilic particles attached to a hydrophobic polymer. The hydrophilic particles absorb moisture from the wound, convert it to a gel at the interface with the wound. Conforms to wound surface; waterproof and bacteria proof.Gel formation at wound interface provides moist wound environment. Dry necrotic wounds, or for wounds with minimal exudate. Also used for granulating wounds.

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AlginateA natural polysaccharide derived from seaweed; available in a range of sizes, as well as in ribbons and ropes.Because highly absorbent, used for wounds with copious exudate. Can be used in rope form for packing exudative wound cavities or sinus tracts.

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AntimicrobialBoth silver and honey are used as antimicrobial elements in dressings.Silver: Requires wound to be moderately exudative to activate the silver, in order to be effective

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CollagenAvailable in several forms, including gels, pads, pastes, particles, sheets, solutions, and are derived from bovine, porcine or avian sources. Collagen dressings are often used for PUs, VLUs, skin donor sites and surgical wounds, arterial ulcers, DFUs, second-degree burns and trauma wounds.

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NPWTComputerized vacuum device applies continuous or intermittent negative or sub-atmospheric pressure to the wound surface. NPWT accelerates wound healing, reduces time to wound closure. Comes in both stationary and portable versions.May be used for traumatic acute wound, open amputations, open abdomen, etc. Seems to increase burn wound perfusion. Also used in management of DFUs. Contraindicated for arterial insufficiency ulcers. Contraindicated if necrotic tissue is present in over 30% of the wound.

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Bioengineered Skin & Skin SubstitutesBio-engineered skin and soft tissue substitutes may be derived from human tissue (autologous or allogeneic), xenographic, synthetic materials, or a composite of these materials.Burns, trauma wounds, DFUs, VLUs, pressure ulcers, postsurgical breast reconstruction, bullous diseases

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Growth FactorsOften derived from human placenta from a healthy delivery (i.e. amniotic tissue allografts) and amniotic fluid components.May be used for any type of wound, but most often used for chronic, non-healing wounds such as DFUs and VLUs, and potentially with second-degree burns.

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Source: MedMarket Diligence, LLC; Report S254.

References   [ + ]

1. Specific companies and products are detailed in “Wound Management to 2026”, report S254

The Human Burden of Wound Care

To the person with a chronic wound, the condition represents pain, social and psychological debilitation and usually a financial load. To society, wound care—and especially the treatment of difficult-to-heal wounds—may represent great human suffering, social discomfort, days lost from work, mental health problems, recurrent infections and great economic burden and the human burden of wound care. Having a chronic wound not only necessitates physical care of the wound, including cleaning, disinfecting, irrigating, and changing dressings; it also impacts the emotional and psychological health of the patient. Depression can set in due to a lower quality of life and dependence on others for care of the wound, as well as for overall assistance, both physical and financial. Wounds may cause odors or may have visible drainage, staining clothing and triggering feelings of embarrassment and shame. These in turn may lead to isolation due to decreased mobility and the fear of being a burden on family and friends. To make things worse, increased stress can slow the progress of wound healing.

In caring for a chronic wound, the dressing costs are only part of the picture; the less visible costs include such items as nursing care, medications for pain and infections, and hospitalization. Hospitalization is a leading cost driver for wound care, accounting for at least 50% of the global economic burden. Nursing time to properly care for the patient with a chronic wound can be lengthy, and this is time that could be spent with other patients. In a new report published in the December 2017 online version of the International Society for Pharmacoeconomics and Outcomes Research’s (ISPOR) Value in Health journal (An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Nussbaum, Samuel R. et al. Value in Health, Volume 21 , Issue 1 , 27 – 32) (see the study), the researchers found that the costs related to wound care in the Medicare population (USA) were much higher than originally estimated, and that care took place primarily in outpatient settings. For the calendar year 2014, there is considerable variation in the estimates originating from different sources:

“Total Medicare spending estimates for all wound types ranged from $28.1 to $96.8 billion. Including infection costs, the most expensive estimates were for surgical wounds ($11.7, $13.1, and $38.3 billion), followed by diabetic foot ulcers ($6.2, $6.9, and $18.7 billion,). The highest cost estimates in regard to site of service were for hospital outpatients ($9.9–$35.8 billion), followed by hospital inpatients ($5.0–$24.3 billion).”

The development of advanced wound care dressings, devices and biologics is helping to change this situation. Although these advanced products may seem (or may be) expensive, they end up saving money for health care systems by healing wounds more rapidly.

Industry Structure

The wound care industry remains quite fragmented, with about eight companies holding leading market shares, but with possibly thousands of small cap companies around the world that are also manufacturing and marketing various wound care products. The Traditional Wound Care space remains attractive, in part since gauze dressings are relatively easy to manufacture and are also still the most commonly-used wound dressing. Even a small company can invent a novel twist to a dressing and experience a rise in profits and inroads into the market.

Low to medium industry concentration. As the traditional and advanced market shares diagrams below demonstrate, there are five to eight major players in Traditional and Advanced Wound Care Markets.

Traditional Wound Care Market Shares, 2017

Source: Report S254, “Wound Management to 2026”.

While these firms account for about 79% and 73% of the total markets, respectively, a significant portion of these markets are covered by hundreds or thousands of Other companies. This low to medium level of concentration means that smaller companies, or large companies looking to break into Wound Care, are able to do so more easily than if, say, three companies controlled 95% of the market.

Johnson & Johnson is estimated to be the Traditional Wound Care market leader with about 26% share, followed by Smith & Nephew, 3M Health Care and Hartmann. Medline Industries is estimated to account for about 8%, while Others account for about 21% of this market.

Breaking into the Advanced Wound Care markets presents a somewhat greater challenge. Here, the leading companies have invested heavily in R&D to gain strategic competitive advantage, as well as to create improved products for patients. Smith & Nephew is holds an estimated 21% of this market, followed by Acelity and Johnson & Johnson with 11% each, and Mölnlycke, 3M Health Care, Hartmann, Cardinal Health and ConvaTec accounting for smaller shares. Here again, Others accounts for at least 27% of this market.

Advanced Wound Care Market Shares, 2017

Source: Report S254. 

Opportunities exist in both Traditional and Advanced Wound Care, especially if a company is in the position of acquiring part or all of an existing wound care company, and if the company can then invest in the development of its new products. If points of distribution overlap, then so much the better.

Relatively low barriers to entry. Good news for companies wishing to break into wound care: barriers to entry into the traditional wound dressing segments (Adherents, Gauze and Non-Adherent Dressings) are relatively low, while demand remains strong. Typically, once a company is established in a traditional segment, it may either plow revenues into research and development, or it may acquire companies to more easily break into new product segments and markets. Many companies in wound care have followed just this path to gain market share and make an impact in the industry.


From, “Wound Management to 2026”; Report S254. Excerpts available on request.

Global Wound Prevalence Forecast by Type, 2016-2026

The clinical driver of sales in wound care is the prevalence of different wound types and the associated cost to manage them. While surgical wounds made by primary intent as part of surgical procedures (e.g., excision of skin lesion, appendectomy, coronary artery bypass graft, etc.) represent the biggest source of wounds, the biggest focus on reining in costs in medtech is slow-healing, chronic wounds, such as ulcers.

We have projected the global prevalence for the most common wound types through 2026, shown below.

Source: MedMarket Diligence, LLC; Report #S254(Request excerpts.)

 

Factors Affecting Wound Healing… (more)

In addition to the factors we detailed in a past post, we show here a number of frameworks used by clinicians to properly assess the condition of wounds and the wound healing process, providing a systematic way to optimize wound healing.

“DIMES”, “TIME” and “DIDNT HEAL”

“DIMES” focuses on providing an efficient use of resources in the management of chronic wounds.

The DIMES Acronym for Treatment Planning and Products

Source: MedMarket Diligence, LLC Report S254; GS Schultz, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003 Mar;11 Suppl 1:S1-28.)

 

“TIME” is focused specifically on wound bed preparation, a key determinant of wound healing.

TIME Acronym for Wound Bed Preparation

Source: MedMarket Diligence, LLC Report S254; GS Schultz, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003 Mar;11 Suppl 1:S1-28.)

 

“DIDNT HEAL” is similarly intended to be a useful mnemonic regarding key wound healing factors.

Source: MedMarket Diligence, LLC Report S254.


March 2018: Worldwide Wound Management, Forecast to 2026″. Report #S254.

Bioengineered Skin and Skin Substitutes, Sales and Growth, 2017 to 2026

The use of bioengineered skin and skin substitutes in the treatment of wounds is on a strong, but variable growth curve. Currently, the highest sales of these products in wound management occurs in the United States, where sales are in excess of $700 million annually already and growth in sales of these products is projected at or near 10% annually through 2026.

While China “only” has sales of just over $200 million in bioengineered skin and skin substitutes, the projected >20% CAGR to 2026 will result in China’s sales approximating U.S. sales in a decade.

Source: MedMarket Diligence, LLC; Report #S254.

Wound Care Market Shares Worldwide

Analyzing data from Report #S254 ,”Wound Management to 2026″, we present the distribution of top competitors’ sales in each segment in 2017. Smith & Nephew, Johnson & Johnson, and 3M dominate the global wound management, with varying dominance between them — or by other companies — in each segment.

Source: MedMarket Diligence, LLC; Report #s254. (Publishing March 2018)

S&N leads the global market, following closely by JNJ. Both companies are active in multiple segments of wound management. S&N has lower traditional wound management product sales (simple dressings and bandages) and higher sales of “advanced” wound management products. J&J does $800 million more sales in traditional dressings, gauze and bandages than S&N, but lesser involvement in newer wound technologies such as NPWT, bioengineered skin, and growth factors.

Source: MedMarket Diligence, LLC; Report #s254. (Publishing March 2018)

 

Country and Regional Variability in Growth of Wound Management Sales

As illustrated in a previous post, wound management products are a spectrum from the simple to the complex:

Source: MedMarket Diligence Report #S254.

Generally, the longer the product has been around (e.g., gauze), the less complex it is compared to emerging technologies…

…BUT simpler is easy to adopt and, with well established sales, growth on a percentage basis will be low (see area in red).

Generally, new technologies incorporate rarer materials, have more complex construction, and may cost considerably more…

…BUT complex technologies may be far more effective clinically than older technologies and may allow treatment where no older technology could, and with low initial sales (penetrated potential), growth on a percentage bases will be high (see area in green).

Country and Regional Variation in Growth Rates

While this size-to-growth dynamic exists for most product types, the dynamic varies from one geographic region to the next. The time point at which a particular product/technology starts to be more rapidly adopted — or the rate at which use of  established products are use starts to decline — can vary considerably from country to country.

As a result, there will be variability in sales growth rates for a product in one country/region versus another.

For example, the 2017 to 2026 compound annual growth rate in sales of Alginates in wound management range from a low of 5.3% in one country to a high of 24.3% in another country. (If you make alginates, in which country would YOU like to compete?)

Regionally, as in USA versus Europe versus Asia/Pacific, etc., there is less variation in growth rates for any given product in that region. For alginates:

country-to-country variation in CAGR: 19%
region-to-region variation in CAGR: 7.8%

In other words, the difference between the countries with the highest and lowest CAGRs for alginate sales is 19%, while the difference between regions shows one region with a 7.8% higher CAGR for alginates than the lowest growth region.

Source: MedMarket Diligence, LLC; Report #S254.

Before chasing after that high growth rate, it is important to know the underlying volume. (Sales of $1 in year 1 and $2 in year 2 is a 100% growth rate, but it’s absolute growth of only $1.)


See the full REPORT, “Wound Management to 2026” details or order online. Please also see the forecast and market share data available separately from the report.

 

Highest growth in wound management sales to 2026 by product, region

Here we assess the specific products and geographic areas showing the highest growth in wound management product sales, drawn from our global report and its forecasts, “Wound Management, Forecast to 2026.”  Report S254.

We assess the 10-year sales size and growth for 13 different wound product segments worldwide, in major geographic regions and individual countries — USA, Rest of N. America, Latin America, Europe, United Kingdom, Spain, France, Germany, Italy, Rest of Europe, Asia/Pacific, Japan, Korea, China, Rest of Asia/Pacific, Rest of World.

Below we show the top 15 combinations of regional market and product segments in descending order of their compound annual growth rate from 2017 to 2026.

Source: MedMarket Diligence, LLC; Report #S254.

As becomes clear, the greatest relative growth in sales in the area of wound management is in several wound care product types — bioengineered skin & skin substitutes, growth factors — and the geographic regions of Japan, Rest of World, China, Germany, Asia-Pacific.  This reflects the high level of investment and attention in Asian markets, especially China.


The complete set of wound market forecast data, from 2016 to 2026, is available at 2018 Wound Management Report #S254, published March 2018.

 

USA slipping behind Asia/Pacific markets in wound care sales

We present data from our 2016 to 2026 forecast of the global market for wound management products (report #S254, published March 2018). 


At a glimpse, you can see the overall trend in global wound management, including the relative size of each market. (The four regional sales charts are shown on the same scale to illustrate this.)  Most notably, the USA dominance of this global market is fading, as aggregate Asia/Pacific sales of all wound products will eclipse USA sales within the forecast period.

 

 

 

 

 

 


Source: MedMarket Diligence, LLC; Report #S254.

Looking at just the aggregate of all wound product types, Asia/Pacific relative sales are squeezing out shares in every other region.Source: MedMarket Diligence, LLC; Report #S254.

When we then look specifically at the USA versus Asia/Pacific, it illustrates that by 2020, Asia/Pacific’s sales of wound management products will eclipse those of the U.S., making it the largest regional wound management market.

Source: MedMarket Diligence, LLC; Report #S254.

Changes in Fortunes for Wound Management Products

Over the 2017 to 2026 period, the compound annual growth rate for the entire wound management market will approach 6%, a respectable rate of growth for an established market, though not quite high enough to encourage investment in the market as a whole.

Of course, the total wound market is comprised of a number of VERY large, slow-growing segments, like traditional adhesive dressings, gauze dressings, and non-adherent dressings, which have annual sales at $3.8 billion, $3.2 billion, and $1.3 billion, respectively.

The large volume, slow growth of the aggregate masks growth in the following segments:

  • Bioengineered skin and skin substitutes
  • Alginates
  • Foam dressings
  • Growth factors

These wound care segments have had, and will continue to have, annual growth rates at or near double-digit through 2026.

The end result of variable growth rates is that the 2026 Wound Care Market (worldwide), by comparison to 2017, will show the following changes (up/down) in each segment’s share of the total market.

Source: MedMarket Diligence, LLC; Report #S254 (publishing Mar. 2018).