Biomedical Engineering Reference
In-Depth Information
portions of the population or they represent massive resource utilization in the care
of smaller numbers of seriously ill or injured patients. The most common disease
processes that require skin replacement include venous stasis ulcers, diabetic
ulcers, pressure ulcers, burns and trauma. The economics of treating these different
etiologies of skin loss vary widely owing to the specifics of the patient population
being treated. However, while a small diabetic ulcer may seem insignificant
compared to a 90% total body surface area burn in terms of cost-to-treat, the
burgeoning epidemic of diabetes, obesity and advanced age in the United States is
making treatment of these wounds a major cost center for the payors and a major
revenue center for companies with skin replacement technologies.
Treatment of wounds in the United States costs the health care system approxi-
mately US$20 billion annually. The three largest causes of complex wounds are
venous, diabetic and pressure ulcers. These problems alone affect up to three
million people and cost the US health care system US$10 billion annually. Total
yearly costs for wound care products for these indications approaches US$2.5
billion. This figure has increased by approximately 20% per annum since 1998.
The characteristics of an ideal skin substitute or replacement have been known
for more than two decades.
1,2
Not surprisingly, replacement skin, like a replace-
ment kidney or lungs, should perform the functions of native skin as closely as
possible. In addition, there are cost and useability issues that are factored into the
equation. The ideal skin substitute is:
•
inexpensive
•
long lasting
•
a bacterial barrier
•
semi-permeable to water
•
elastic
•
easy to apply
•
painless to the patient
•
non-antigenic and non-toxic
•
cosmetically acceptable
•
durable.
2.2 Indications for skin replacement
The advanced wound care market is enormous and growing. The major etiologies
of complex wounds in the United States include venous, diabetic and pressure
ulcers. Other high-cost wounds include burns and infections involving the skin and
soft tissues. Wound care has become a multimodality specialty with the utilization,
in some circumstances, of negative pressure therapy, bioengineered skin substi-
tutes and growth factors, ultrasound or combinations of these. In this section, the
major indications for the use of skin substitutes and wound care products will be
covered. Special attention will be paid to the epidemiology and cost of treating
these conditions.
