Chronic Non-healing Wounds
In the United States, chronic wounds affect around 6.5 million patients. It is claimed that an excess of US$25 billion is spent
annually on treatment of chronic wounds and the burden is growing rapidly due to increasing health care costs, an aging population
and a sharp rise in the incidence of diabetes and obesity worldwide. The annual wound care products market is projected to
reach $15.3 billion by 2010. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact,
chronic wound patients frequently suffer from "highly branded" diseases such as diabetes and obesity. This seems to have overshadowed
the significance of wounds per se as a major health problem.
The immense economic and social impact of wounds in our society calls for allocation of a higher level of attention and
resources to understand biological mechanisms underlying cutaneous wound complications. Investment in the detailed scrutiny
of wounds presented clinically as well as in pre-clinical models seems prudent.
Infection and Biofilms
An important factor in the failure of a sore to heal is the presence of multiple species of bacteria, living cooperatively
in highly organized biofilms. The biofilm protects the bacteria from antibiotic therapy and the patient’s immune response.
Among others, cutaneous wounds lend themselves to infection by methicillin-resistant Staphylococcus aureus (MRSA).
Wounds cannot begin to heal if infection is present. It is therefore necessary to first clear the infection, which in chronic infections are typically
biofilms. The elimination of infections, with and without biofilms, is complicated by diabetes, which tends to lower circulation and
therefore the ability for antibiotics to reach the infection. Further, antibiotics are ineffective when applied topically.
The combination of biofilms and poor circulation tend to make these types of infections highly resistant to antibiotics.
According to the National Pressure Advisory Panel, a pressure ulcer is localized injury to the skin and/or underlying tissue
usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.
Vulnerable patients include the elderly, stroke victims, patients with diabetes, dementia, those in wheelchairs,
bedridden or suffering from impaired mobility or sensation. Pressure ulcers can be a major source of infection and lead to
complications such as septicaemia, osteomyelitis and, even death.
Ulcers and other foot complications are responsible for 20% of the nearly 3 million hospitalizations every year related to
diabetes. Many of these patients eventually must undergo lower extremity amputations as a result of infection brought on by
untreated foot ulcers.
Venous ulcers account for 70%–90% of ulcers found on the lower leg. Up to one-third of treated patients experience four or more episodes of recurrence.
Acute wound care is indicated in all patients with surgical and traumatic wounds, abrasions, or superficial burns.
Every time an incision is made a wound is created. Wound infections are the most expensive complications following surgery and
still after many years are a major source of bacteria that drive the nosocomial infection rates in hospitals.
Treatment of Chronic Non-healing Wounds
Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy
Chandan K. Sen, PhD, Gayle M. Gordillo, MD, Sashwati Roy, PhD, Robert Kirsner, MD, Lynn Lambert, CHT, Thomas K. Hunt, MD, Finn Gottrup, MD, Geoffrey C Gurtner, MD, and Michael T. Longaker, MD