What are Chronic Wounds?
Chronic wounds are a prevalent health challenge that affect millions of individuals globally. In developed countries, 1-2% of the population develops a chronic ulcer during their lifetime. In the U.S., this amounts to over 6.5 million patients costing the healthcare system over $25 billion, with those numbers expected to increase in coming years alongside an aging population (De Moya et al.). There is no clear definition of chronicity, but in general chronic wounds exhibit impaired healing and last over four weeks (De Moya et al.). Chronic wounds are commonly classified into four types: venous ulcers, arterial insufficiency ulcers, diabetic ulcers, and pressure ulcers (Robson and Barbul 2006). Causes of ulceration include vascular conditions, immunodeficiency, metabolic conditions like diabetes, infection, and prolonged pressure application (Grey et al. 2006).
Pressure ulcers, also known as bedsores, are common in nursing homes, long-term rehabilitation facilities, and intensive care units. The National Pressure Ulcer Advisory Panel has established a system for characterizing these wounds into six stages: stages 1-4, unstageable, and suspected deep tissue injury. In the U.S. this system is standard for research and clinical wound assessment (Zulkowski). Stage 1 has intact skin, stage 2 has partial-thickness skin loss, stage 3 has full-thickness skin loss, and stage 4 has full-thickness skin loss with exposed muscle, bone, or ligament (Edsberg et al. 2016). Although other types of chronic wounds may not explicitly fall under this classification system, there is often mixed etiology of ulcers, and all four types have common characteristics and vary in severity (Zulkowski). Additionally, all four types of ulcers share similarities in assessment and treatment (Robson and Barbul 2006).
Pressure ulcers, also known as bedsores, are common in nursing homes, long-term rehabilitation facilities, and intensive care units. The National Pressure Ulcer Advisory Panel has established a system for characterizing these wounds into six stages: stages 1-4, unstageable, and suspected deep tissue injury. In the U.S. this system is standard for research and clinical wound assessment (Zulkowski). Stage 1 has intact skin, stage 2 has partial-thickness skin loss, stage 3 has full-thickness skin loss, and stage 4 has full-thickness skin loss with exposed muscle, bone, or ligament (Edsberg et al. 2016). Although other types of chronic wounds may not explicitly fall under this classification system, there is often mixed etiology of ulcers, and all four types have common characteristics and vary in severity (Zulkowski). Additionally, all four types of ulcers share similarities in assessment and treatment (Robson and Barbul 2006).
The Burden of Chronic Wound Care
The prevalence of chronic wounds imposes a significant cost on healthcare systems, hospitals, and patients. Pressure ulcers alone cost the U.S. healthcare system $9.1-11.6 billion annually, with a single stage 3 wound treatment costing $5900-14,840 and overall adding $43,180 on average to an individual’s hospital stay (Bauer et al. 2016). Wound dressings and other care products are one of the cost drivers and thus an area for improvement. Insurers such as Medicare only cover dressings for as long as they are deemed “medically necessary” and accompanied by appropriate documentation, so hospitals and patients may acquire the costs of these supplies if wounds do not meet certain requirements (Center for Medicare & Medicaid Services). Furthermore, research indicates that publicly-reported mean healing rates of 92% are severely misleading, and it is likely that healing rates over 40% are unrealistic based on U.S. Wound Registry data. At 12 weeks follow-up, only 30.5% of diabetic foot ulcers, 29.6% of pressure ulcers, and 44.1% of venous leg ulcers are healed (Fife et al. 2018). The need for wound dressings and bandages exists regardless of the care setting, whether it be in outpatient departments, skilled nursing facilities, or at home, and the global medical tape and bandage market, valued at $7 billion in 2016, is expected to keep growing (Grand View Research 2016). Individualizing bandages has a widespread opportunity to significantly improve waste efficiency and the healing progression of chronic wounds through customized treatments.
How Can We Improve Chronic Wound Care?
Currently, most dressings come in standard square, rectangular, or oval shapes that can be cut to size by the clinician at time of use. Many ulcers that are stage 2 and above have asymmetric morphologies, including undermining and tunneling, and may require packing (Dabiri et al. 2016). Consideration of wound morphology, especially for complex chronic wounds, is important for healing kinetics, so being able to analyze such morphologies and use the information to inform care practices and supplies is beneficial (Javierre et al. 2009). Manual cutting of bandages or dressings to individualize wound care naturally leads to wastefulness, imprecision, and sterility concerns that can impair the healing process and further raise costs. Based on the increasing elderly population and ubiquitous and costly nature of chronic wounds, there is economic and medical benefit to optimizing wound care practices and supplies. By improving the clinician’s ability to monitor chronic wounds and use appropriately-sized bandages for treatment, wound care will become more efficient for clinicians and thereby improve patient experience and healing.