Wound healing and Surgical Closure

Traumatic and surgical wounds, which were once treated with little more than bandages to keep out debris and otherwise let natural healing run its course, are now the target of an incredible array of products, technologies and approaches to optimize wound healing — speeding the healing process while endeavoring to reduce the overall cost of wound management, particularly for chronic wounds. Two major phases of wound management drive the development of wound care products: wound closure and wound healing. Wound closure addresses the most immediate demand of wounds in restoring the structural integrity of tissues (skin, fascia, organs, etc) to minimize blood loss, risk of infection or other traumatic sequellae. Wound healing products are focused on providing an ideal environment for the normal cascade of wound healing processes to take place, including the actions of cellular, protein and other tissue constituents. (The diversity of wound management products encompassing varied dressings, tissue engineering, growth factors and others are dealt with in MMD report #S247, while products specific to wound closure and securement are the focus of MMD report #S180.) A useful starting point for determining which adjunctive surgical closure and securement products are appropriate for different wound healing treatments is to recognize the major distinction between different wound types. Surgical wounds are usually appropriate for treatment with adjunctive surgical closure and securement products because they are created under clean conditions, the usual acute healing cascade of events begins immediately and control of the bleeding and closure process can lead to accelerated healing, improved prognosis, and enhanced aesthetic effects such as reduced scarring. Surgical wounds offer the potential for devices to ensure hemostasis, prevent internal adhesions and anastomoses, soft tissue securement, and closure of the skin. Traumatic wounds also offer potential for skin closure products and for hemostats, and adhesion prevention during post- trauma surgery. New wound-covering sealant products may also offer potential for treatment of cuts, grazes, and burns. Chronic wounds are generally not amenable for treatment by adhesives, sealants and hemostats unless the wound has been debrided to a sterile bleeding surface (in which case it becomes like a surgical wound), or the product offers some stimulant activity; many hemostats exhibit some inflammatory and cytokinetic activity, which has been associated with accelerated healing. To help determine how these applications for closure and securement products may translate into market potential, it is relevant to note the incidence of the different types of wounds; Exhibit 1-5 gives this data.