Wound management practice patterns, products by wound type

From Report #S251, “Wound Management to 2024”.

Surgical wounds account for the vast majority of skin injuries. We estimate that there are approximately 100 million surgical incisions per year, growing at 3.1% CAGR, that require some wound management treatment. About 16 million operative procedures were performed in acute care hospitals in the USA. Approximately 80% of surgical incisions use some form of closure product: sutures, staples, and tapes. Many employ hemostasis products, and use fabric bandages and surgical dressings.

Surgical procedures generate a preponderance of acute wounds with uneventful healing and a lower number of chronic wounds, such as those generated by wound dehiscence or postoperative infection. Surgical wounds are most often closed by primary intention, where the two sides across the incision line are brought close and mechanically held together. Overall the severity and size of surgical wounds will continue to decrease as a result of the continuing trend toward minimally invasive surgery.

Surgical wounds that involve substantial tissue loss or may be infected are allowed to heal by secondary intention where the wound is left open under dressings and allowed to fill by granulation and close by epithelialization. Some surgical wounds may be closed through delayed primary intention where they are left open until such time as it is felt it is safe to suture or glue the wound closed.

Traumatic wounds occur at the rate of 50 million or more every year worldwide. They require cleansing and treatment with low-adherent dressings to cover the wound, prevent infection, and allow healing by primary intention. Lacerations are a specific type of trauma wound that are generally minor in nature and require cleansing and dressing for a shorter period. There are approximately 20 million lacerations a year as a result of cuts and grazes; they can usually be treated in the doctors’ surgery, outpatient medical center or hospital A&E departments.

Burn wounds can be divided into minor burns, medically treated, and hospitalized cases. Outpatient burn wounds are often treated at home, at the doctor’s surgery, or at outpatient clinics. As a result, a large number of these wounds never enter the formal health service system. According to the World Health Organization (WHO), globally about 11 million people are burned each year severely enough to require medical treatment. We estimate that approximately 3.5 million burns in this category do enter the outpatient health service system and receive some level of medical attention. In countries with more developed medical systems, these burns are treated using hydrogels and advanced wound care products, and they may even be treated with consumer-based products for wound healing.

Medically treated burn wounds usually receive more informed care to remove heat from the tissue, maintain hydration, and prevent infection. Advanced wound care products are used for these wounds. There are approximately 6.0 million burns such as this that are treated medically every year.

Hospitalized burn wounds are rarer and require more advanced and expensive care. These victims require significant care, nutrition, debridement, tissue grafting and often tissue engineering where available. They also require significant follow-up care and rehabilitation to mobilize new tissue, and physiotherapy to address changes in physiology. Growth rates within the burns categories are approximately 1.0% per annum.

Chronic wounds generally take longer to heal, and care is enormously variable, as is the time to heal. There are approximately 7.4 million pressure ulcers in the world that require treatment every year. Many chronic wounds around the world are treated sub-optimally with general wound care products designed to cover and absorb some exudates. The optimal treatment for these wounds is to receive advanced wound management products and appropriate care to address the underlying defect that has caused the chronic wound; in the case of pressure ulcers a number of advanced devices exist to reduce pressure for patients. There are approximately 9.7 million venous ulcers, and approximately 10.0 million diabetic ulcers in the world requiring treatment. Chronic wounds are growing in incidence due to the growing age of the population, and the growth is also due to increasing awareness and improved diagnosis. Growth rates for pressure and venous ulcers are 6%–7% in the developed world as a result of these factors.

Diabetic ulcers are growing more rapidly due mainly to increased incidence of both Type I and maturity-onset diabetes in the developed countries around the world. The prevalence of diabetic ulcers is rising at 9% annually. Every year 5% of diabetics develop foot ulcers and 1% require amputation. The recurrence rate of diabetic foot ulcers is 66%; the amputation rate rises to 12% with subsequent ulcerations. At present, this pool of patients is growing faster than the new technologies are reducing the incidence of wounds by healing them.

Wound management products are also used for a number of other conditions including amputations, carcinomas, melanomas, and other complicated skin cancers, all of which are on the increase.

A significant feature of all wounds is the likelihood of pathological infection occurring. Surgical wounds are no exception, and average levels of infection of surgical wounds are in the range of 7%–10%, depending upon the procedure. These infections can be prevented by appropriate cleanliness, surgical discipline and skill, wound care therapy, and antibiotic prophylaxis. Infections usually lead to more extensive wound care time, the use of more expensive products and drugs, significantly increased therapist time, and increased morbidity and rehabilitation time. A large number of wounds will also be sutured to accelerate closure, and a proportion of these will undergo dehiscence and require aftercare for healing to occur.

For the detailed coverage of wounds, wound management products, companies, and markets, see report #S251, “Worldwide Wound Management to 2024”.

Advanced wound care technologies target high costs, according to new MedMarket Diligence report

September 21, 2009 (For Immediate Release)

While the huge $5 billion global market for wound management technologies may not suggest it, many of its products are designed to target the high cost of wound healing. Chronic wounds and non-healing wounds. See the 2009 MedMarket Diligence report.

FOOTHILL RANCH, CA — Advanced wound management technologies — those used in the clinical management of wounds (not OTC) — represent a $5 billion global market that will triple in the next ten years.  These technologies have continued to evolve beyond simple dressings and bandages to be able to accelerate wound healing, improve clinical outcomes and, in particular, attempt to reduce the cost of managing wound types like arterial, venous, diabetic and stasis ulcers.

The distribution of the advanced wound care market across these different wound care types has continued to shift, especially with the development and application of more expensive wound care technologies, which have been incentivized by the high cost of chronic wounds.  Physical therapies, which include negative pressure devices, positive pressure devices, mechanically assisted wound closure, hydrotherapy, electrical stimulation, ultraviolet therapy and others, are demonstrating the largest relative growth.

The MedMarket Diligence report, "Worldwide Wound Management, 2009:  Established and Emerging Products, Technologies and Markets in the U.S., Europe, Japan and Rest of World," published September 2009, details the complete range of products and technologies used in wound management and wound care, from dressings, bandages, hydrogels, tissue engineered products, physical treatments and others. The report details current clinical and technology developments in this huge worldwide market with high growth sectors, with data on products in development and on the market; market size and forecast; competitor market shares; competitor profiles; and market opportunity. The report provides full year (actual) 2008 market size and share data, with forecast market data to 2017, for the U.S., Europe, Asia/Pacific and Rest of World.

"The intense focus of healthcare reform on the cost of medical technologies might examine wound management as a cost driver, but the reality of products and development in this area is that the high cost of chronic or non-healing wounds is the prime target of the wound management industry’s efforts," says Patrick Driscoll of MedMarket Diligence, publisher of the 2009 Worldwide Wound Management Market report.  According to Driscoll, the high direct and indirect costs of chronic wounds have created an economic opportunity that sustains advanced technology development.  This does not make wound care exempt from the focus of healthcare reform, but does weaken the argument against the "high costs" of advanced technology development.

The report is described in detail at http://mediligence.com/rpt/rpt-s247.htm. It may be purchased online at http://mediligence.com/store/page31.html or it may be ordered via fax order form http://mediligence.com/order_forms/s247_order.pdf.

Tags: woundcare, wound management

 

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Purchase for download: "Wound Management 2009 (PDF)" — $3,250.00
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High medical cost the target of chronic wound treatments

Chronic wounds — which persist as a result of poor local circulation, localized pressure and other causes, alone or in combination — are responsible for high and growing costs in healthcare.  Being more prevalent in the growing, aging population due to their higher incidence of pressure ulcers, diabetic ulcers, the chronic wound a problem that is becoming more and more pronounced.

There is an incidence of approximately 5.2 million pressure ulcers in the world that require treatment every year. Optimally, these wounds receive advanced wound management products and appropriate care to address the underlying defect that has caused the chronic wound. Pressure ulcers are caused by compression of the skin and underlying tissues, as when a patient is bedridden and the buttocks are pressed onto the mattress; a number of advanced devices exist to reduce pressure for patients. Other skin ulcers are caused by poor circulation, even without the added complication of pressure. There are approximately 7.6 million venous ulcers, and approximately 7.0 diabetic ulcers in the world requiring treatment.

Chronic wounds are growing in incidence due to the growing numbers of elderly individuals in the population, and the caseload is also increasing due to improved diagnosis and education. At present these factors are contributing to growth of this pool of patients faster than new technologies are reducing the incidence of wounds by healing them.


There is a common perception that medical technologies are responsible for the high cost of healthcare in the U.S.   One can make strong arguments that a number of medical technologies are simply overused (many critics point to overused advanced imaging technologies).  However, providing solutions to high healthcare costs has been an area of attention and opportunity in the eyes of medtech companies since well before the current or prior attempts at healthcare reform.  And now, in today’s climate, new medical technologies are even more likely to be challenged for their potential to increase costs, and manufacturers therefore understand full well that their new product innovations must either make a moderately convincing case that each new technology will lower cost or make an overwhelming case that it will dramatically improve quality of life treating previously untreated, or significantly under-treated, conditions.  The high costs of chronic wounds represent a prime example and therefore have been and will be subject to advanced medical technology development.


Drawn from the pending September 2009 report #S247, "Worldwide Wound Management Market, 2008-2007."

Surgical, traumatic, burn, and chronic wounds driving wound care products market

See also the 2013 Report #S249, “Wound Management, Worldwide Market and Forecast to 2021:  Established and Emerging Products, Technologies and Markets in the Americas, Europe, Asia/Pacific and Rest of World”.

Wound management encompasses a wide range of products: fabric dressings, first aid dressings, dressings and internal wound management products for surgery, advanced wound management products, active pharmaceutical wound care products, tissue engineering, physical therapies for wound care, and pressure relief products and skin treatments, for preventative wound management.

MedMarket Diligence is finalizing its analysis (publication September 2009) of the global market for wound management products (Report #S247).  Following is an excerpt from the 2007 analysis (provided as a point of reference only;  more current data is under review).


WOUND PREVALENCE

Surgical Wounds

Surgical wounds account for the vast majority of skin injuries. We estimate that there are over 100 million surgical incisions a year requiring some wound management treatment. Approximately 80% of these wounds use some form of closure product (sutures, staples, and tapes). Many employ hemostasis products, and use fabric bandages and surgical dressings.

Surgical wounds are projected to increase in number at an annual rate of 3.1%, but overall the severity and size of surgical wounds will continue to decrease over the next ten years as a result of the continuing trend toward minimally invasive surgery.

Surgical procedures generate a preponderance of acute wounds with uneventful healing and a lower number of chronic wounds, such as those generated by wound dehiscence or post-operative infection. Surgical wounds are most often closed by primary intention, using products such as sutures, staples, or glues, where the two sides across the incision line are brought close and mechanically held together. Surgical wounds that involve substantial tissue loss or may be infected are allowed to heal by secondary intention where the wound is left open under dressings and allowed to fill by granulation and close by epithelialization. Some surgical wounds may be closed through delayed primary intention where they are left open until such time as it is felt it is safe to suture or glue the wound closed.

A significant feature of all wounds is the likelihood of pathological infection occurring. Surgical wounds are no exception, and average levels of infection of surgical wounds are 7 to 10 percent dependent on the procedure. These infections can be prevented by appropriate cleanliness, surgical discipline and skill, wound care therapy, and antibiotic prophylaxis. Infections usually lead to more extensive wound care time, the use of more expensive products and drugs, significantly increased therapist time, and increased morbidity and rehabilitation time. A large number of wounds will also be sutured to accelerate closure, and a proportion of these will undergo dehiscence and require aftercare for healing to occur.

Traumatic Wounds

There are estimated to be 1.5 million cases of traumatic wounding every year. These wounds required cleansing and treatment with low adherent dressings to cover them, prevent infection, and allow healing by primary intention. Lacerations are a specific type of trauma wound that are generally more minor in nature and require cleansing and dressing for a shorter period of healing. Lacerations occur frequently (approximately 19 million cases a year) as a result of cuts and grazes and can usually be treated within the doctor’s surgery and outpatient medical center and hospital accident and emergency department.

Burns

Burn wounds can be divided into minor burns, medically treated, and hospitalized cases. Out-patient burn wounds are often treated at home, at the doctor’s surgery, or at outpatient clinics. As a result a large number of these wounds never enter the formal health service system. We estimate that approximately 3.3 million burns in this category do enter the outpatient health service system and receive some level of medical attention. These burns use hydrogels and advanced wound care products, and may even be treated with consumer based products for wound healing. Medically treated burn wounds usually get more informed care to remove heat from the tissue, maintain hydration, and prevent infection. Advanced wound care products are used on these wounds. Approximately 6.3 million burns like this are treated medically every year. Hospitalized burn wounds are rarer and require more advanced and expensive care. These victims require significant care, nutrition, debridement, tissue grafting and often tissue engineering where available. They also require significant aftercare and rehabilitation to mobilize new tissue, and physiotherapy to address changes in physiology.

Chronic Wounds

Chronic wounds generally take longer to heal and care is enormously variable, as is the time to healing. There are approximately 7.4 million pressure ulcers in the world that require treatment every year. Many chronic wounds around the world are treated sub-optimally with general wound care products designed to cover and absorb some exudate. The optimal treatment for these wounds is to receive advanced wound management products and appropriate care to address the underlying defect that has caused the chronic wound; in the case of pressure ulcers the causal effect is pressure and a number of advanced devices exist to reduce pressure for patients. There are approximately 11 million venous ulcers, and 11.3 million diabetic ulcers in the world requiring treatment. Chronic wounds are growing in incidence due to the growing age of the population, and due mostly to awareness and improved diagnosis. At present these factors are contributing to growth of this pool of patients faster than the new technologies are reducing the incidence of wounds by healing them.

Wound management products are also used for a number of other conditions including amputations, carcinomas, melanomas, and other complicated skin cancers, which are all on the increase.

Worldwide Wound Prevalence by Etiology

wound-prevalence

Source:  MedMarket Diligence report #S247 (See also the 2013 report #S249)


(See also the related report #S175 on “Worldwide Surgical Sealants, Glues and Wound Closure, 2009-2013.”)

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Dermal repair disorders, prevalence and applications for securement products

Skin securement has always been an essential final step in surgical procedures. Historically, the skin surface was sutured; in recent years a number of advances have been made, including new tapes, sutures, staples, hemostats, and glues.  High strength glues, in particular, find some of their biggest potential in dermal applications, given the problems of, for example, cyanoacrylate toxicity for internal applications.

The applications for skin securement are categorized by burns, ulcers (pressure, venous) and plastic surgery.  While the most acute need is in the area of burn treatment, the vast majority of procedures in skin securement are comprised of ulcers and plastic surgery. 

dermal-repairPressure ulcers develop in immobile patients who often suffer from underlying biochemical deficiencies that lead to inadequate skin healing. Prevalence is highest in the old and infirm, and incidence is increasing in line with aging of the population. Sealants, hemostats, and closure products provide opportunities for a radical surgical method to treat these life-threatening wounds, which normally would be treated with conservative (though often sophisticated) wound healing products designed to reduce points of pressure, mask smell and absorb excess moisture while the body repairs itself. The strongest opportunity for use of surgically oriented products for repair of pressure ulcers is among young paraplegics and short-term acute care patients who are immobilized but otherwise healthy (approximately 5% of all pressure ulcers).

In diabetic ulcers, diabetes causes many abnormalities in tissue biochemistry and nutrition, many of which lead to impaired tissue healing. In addition, diabetes leads to conditions of hypoxia and peripheral neuropathy that can directly cause ulcers. Approximately 800,000 diabetics in the United States have diabetic foot ulcers; closure and securement products offer a surgical route to aiding repair that may offer potential to accelerate repair in a number cases.

There are approximately one million venous ulcer patients in the United States today. Prevalence is increasing in line with aging demographics exacerbated by a sedentary lifestyle. Venous ulcers are caused by underlying vascular and venous flow abnormalities, which can often be treated by knowledgeable application of pressure bandaging and, in some cases, appropriate topical wound care. However, this treatment is largely symptomatic and many physicians believe surgical intervention to repair the underlying vascular abnormalities is required to effect a cure and avoid tissue breakdown. Sealants, hemostats, and closure products offer a surgical route to aiding repair that may offer potential to accelerate repair in a number cases.

About 2 million plastic surgery (cosmetic) procedures are performed in the United States every year. The most popular procedures are liposuction (455,000) and breast augmentation (365,000). Most of the latter use synthetic materials and biomaterials for augmentation purposes. Other procedures where sealant products may be relevant include rhinoplasty (200,000), abdominoplasty (170,000) and eyelid surgery (230,000).

Adjunctive products for securement and closure offer potential to improve surgical procedure, reduce infections, and improve aesthetic and physiological properties of newly repaired tissues, as well as offering more rapid rehabilitation and the avoidance of donor site morbidity in approximately 27,000 of these operations involving the use of donated tissue from another region of the patient’s body.


See report #S175, "Worldwide Surgical Sealants, Glues and Wound Closure Market."

Dermal repair and market for securement products worldwide

Skin securement (sealing, closure, hemostasis, etc.) has always been an essential final step in surgical procedures. In early years, the skin surface was sutured; in recent years a number of advances have been made, including new tapes, sutures, staples, hemostats, and glues.

Treatments for skin or dermal repair by surgical securement products represent a worldwide caseload of over 20 million annually.  Burns represent the most serious of these cases, but roughly 25% of patients with burns die from them and overall are far fewer than ulcers.  Ulcers, which may be caused by inadequate circulation, biochemical deficience or other causes, are a high volume, high cost caseload worldwide and, as such, drive considerable interest in the development of improved treatments.  Nonetheless, the highest volume application in dermal repair in western civilization is plastic surgery.

Potential caseload is segmented by geography and skin repair type for the use of securement products, and is shown below:

ulcer-usa1

ulcer-europe

ulcer-row

Source:  MedMarket Diligence, LLC; Report #S175, "Worldwide Surgical Sealants, Glues and Wound Closure, 2009-2013,"