Wound Care Markets 2012

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CHAPTER ONE: EXECUTIVE SUMMARY ............................................................... 1

Introduction ............................................................................................................................... 1
Scope and Methodology ............................................................................................................ 2
Size and Growth of the Market................................................................................................ 3
Trends Affecting the Market.................................................................................................... 5
Competitive Outlook ................................................................................................................. 6

CHAPTER TWO: INTRODUCTION AND OVERVIEW........................................... 7

Functions of Skin ....................................................................................................................... 7
Normal Integument ................................................................................................................... 8
Epidermis .............................................................................................................................................. 8
Dermis................................................................................................................................................... 9
Subcutaneous Tissue ............................................................................................................................. 9
Effects of Aging on the Integumentary System .................................................................... 10
Types of Wound Healing ........................................................................................................ 11
Wound Healing Process .......................................................................................................... 11
Delays of Wound Healing ....................................................................................................... 12
Complications of Wound Healing .......................................................................................... 13
Hypertrophic Scars and Keloid Formation......................................................................................... 13
Contracture ......................................................................................................................................... 13
Dehiscence .......................................................................................................................................... 14
Excess Granulation Tissue .................................................................................................................. 14
Adhesions ............................................................................................................................................ 14

CHAPTER THREE: MAIN TYPES OF WOUNDS ................................................... 15

Skin Ulcers ............................................................................................................................... 15
Pressure or Decubitus Ulcers ............................................................................................................. 15
Diabetic Ulcers or Neuropathic Ulcers .............................................................................................. 17
Arterial Ulcers .................................................................................................................................... 17
Venous Ulcers ..................................................................................................................................... 18
Burns ........................................................................................................................................ 19
Thermal Injury .................................................................................................................................... 19
Chemical Injury .................................................................................................................................. 20
Electrical Injury .................................................................................................................................. 20
Depth Classification............................................................................................................................ 20
Surgical Wounds ..................................................................................................................... 23
Trauma Wounds ..................................................................................................................... 24

CHAPTER FOUR: PRODUCTS .................................................................................. 27

Anti-Infectives ......................................................................................................................... 27
Industry Innovations ........................................................................................................................... 29
Compression and Composite Dressings ................................................................................ 31
Industry Innovations ........................................................................................................................... 33
Sutures ..................................................................................................................................... 36
Absorbable .......................................................................................................................................... 37
Synthetic Absorbable Polymers .......................................................................................................... 40
Nonabsorbable .................................................................................................................................... 41
Surgical Silk ........................................................................................................................................ 42
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Surgical Cotton ................................................................................................................................... 42

Linen ................................................................................................................................................... 42
Surgical Stainless Steel ....................................................................................................................... 43
Synthetic Nonabsorbable Polymers .................................................................................................... 43

Staplers and Staples ................................................................................................................ 43

Tissue Adhesives, Sealants and Glues ................................................................................... 45
Fibrin-based........................................................................................................................................ 46
Collagen-based ................................................................................................................................... 46
Vascular Closing Devices ................................................................................................................... 46
Polymeric Sealants.............................................................................................................................. 47
Synthetic Adhesives/Glues................................................................................................................... 47
Industry Innovations ........................................................................................................................... 48
Tapes ........................................................................................................................................ 49
Dry Dressings........................................................................................................................... 50
Industry Innovations ........................................................................................................................... 51
Cleansing .................................................................................................................................. 54
Debridement........................................................................................................................................ 57
Industry Innovations ........................................................................................................................... 58
Alginates................................................................................................................................... 61
Industry Innovations ........................................................................................................................... 61
Hydrocolloids ........................................................................................................................... 63
Industry Innovations ........................................................................................................................... 63
Hydrogels ................................................................................................................................. 65
Industry Innovations ........................................................................................................................... 66
Films ......................................................................................................................................... 69
Industry Innovations ........................................................................................................................... 70
Foam Dressings ....................................................................................................................... 72
Industry Innovations ........................................................................................................................... 74
Artificial Skin .......................................................................................................................... 78
Industry Innovations ........................................................................................................................... 78
Collagen ................................................................................................................................... 81
Industry Innovations ........................................................................................................................... 82
Growth Factors ....................................................................................................................... 84
Negative Pressure Wound Therapy ....................................................................................... 86
Industry Innovations ........................................................................................................................... 88
Pressure Relief ......................................................................................................................... 90
Industry Innovations ........................................................................................................................... 91
Miscellaneous ........................................................................................................................... 96
Electrical Stimulation ......................................................................................................................... 96
Ultraviolet ........................................................................................................................................... 98
Oxygen and Hyperbaric Oxygen ......................................................................................................... 98
Whirlpool Therapy .............................................................................................................................101
Electromagnetic Therapy Device .......................................................................................................102
Ultrasound .........................................................................................................................................102
Low Intensity Laser Therapy..............................................................................................................103
Other Therapies .................................................................................................................................104

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CHAPTER FIVE: TOTAL MARKET SIZE, FORECAST AND

COMPETITIVE ANALYSIS ..................................................................................... 107
Total Market by Segment ..................................................................................................... 110
Market by Type ..................................................................................................................................110
Market by Region ...............................................................................................................................113
Competitive Market Summary ............................................................................................ 116

CHAPTER SIX: INDUSTRY DEVELOPMENTS ................................................... 129

World Demographics ........................................................................................................................130
Scars ....................................................................................................................................... 137
Honey Treatment .................................................................................................................. 139
Healthcare System and Reimbursement by Country ........................................................ 142
United States ......................................................................................................................................142
Reimbursement Developments ...........................................................................................................148
United Kingdom .................................................................................................................................149
Germany.............................................................................................................................................150
Spain ..................................................................................................................................................150
Italy ....................................................................................................................................................150
France ................................................................................................................................................151
Japan..................................................................................................................................................151
Emerging Markets ..............................................................................................................................151
Electronic Medical Records ................................................................................................. 151
Mesenchymal Stem Cell Use in Wound Care ..................................................................... 154
Telemedicine and Wound Care............................................................................................ 155
Vitamin D ............................................................................................................................... 159
APPs for Wound Care .......................................................................................................... 159
Obesity and Wound Healing ................................................................................................ 159
Regulatory Issues .................................................................................................................. 160
Non-Payment Events............................................................................................................. 161
Evidence-Based Wound Care............................................................................................... 161
Silver Toxicity ........................................................................................................................ 162
Home Care ............................................................................................................................. 164
Wound Care Technologies ................................................................................................... 164
Approved Products.............................................................................................................................165
Products in Development ...................................................................................................................167
Wound Care Clinics .............................................................................................................. 168

CHAPTER SEVEN: CONCLUSIONS ....................................................................... 171

Conclusions ............................................................................................................................ 171

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CHAPTER EIGHT: COMPANY PROFILES........................................................... 173

Overview ................................................................................................................................ 173
Advanced BioHealing ........................................................................................................... 176
Baxter BioScience .................................................................................................................. 178
Coloplast A/S ......................................................................................................................... 180
Covidien, Ltd. ........................................................................................................................ 184
Derma Sciences ...................................................................................................................... 187
GlaxoSmithKline Plc............................................................................................................. 190
Healthpoint Biotherapeutics ................................................................................................ 192
Hill-Rom Company, Inc. ...................................................................................................... 194
Hollister Wound Care LLC ................................................................................................. 196
Johnson & Johnson ............................................................................................................... 197
Lohmann and Rauscher GmbH ........................................................................................... 199
Kensey Nash Corporation .................................................................................................... 200
Kinetic Concepts, Inc. ........................................................................................................... 201
Medline Industries ................................................................................................................ 204
MoInlycke HealthCare ......................................................................................................... 206
Pfizer, Inc. .............................................................................................................................. 208
Smith & Nephew, plc ............................................................................................................ 210
Systagenix Wound Management ......................................................................................... 213

APPENDIX: COMPANY DIRECTORY ................................................................... 215

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L


CHAPTER ONE: EXECUTIVE SUMMARY 
Summary Table: Total Worldwide Wound Care Market Revenues 2009-2016 .......................... 4
Summary Figure: The Worldwide Wound Care Market Revenues 2009-2016........................... 5

CHAPTER THREE: MAIN TYPES OF WOUNDS 

Table 3-1: Common Sites for Pressure Ulcer Development ........................................................ 16

CHAPTER FOUR: PRODUCTS 

Table 4-1: Selected Topical Brand Name Anti-Infectives Currently Available
(Product, Active Ingredient, Manufacturer) ............................................................................. 30
Table 4-2: Selected Compression and Composite Dressings and Bandages
Currently on the Market ............................................................................................................. 35
Table 4-3: Selected Absorbable Sutures by Manufacturers and Products ................................ 38
Table 4-4: Selected Nonabsorbable Sutures by Manufacturers and Products .......................... 41
Table 4-5: Selected Staplers and Staples Manufacturers and Products ..................................... 45
Table 4-6: Selected Tissue Adhesives, Sealants, and Glues
Manufacturers and Products ....................................................................................................... 49
Table 4-7: Selected Adhesive Strips and Tapes Currently on the Market ................................. 50
Table 4-8: Selected Dry Dressing (Woven and Nonwoven) Currently on the Market .............. 53
Table 4-9: Toxicity Index for Selected Wound Cleansers ............................................................ 55
Table 4-10: Selected Cleansing Agents Currently on the Market ............................................... 57
Table 4-11: Selected Debridement Agents..................................................................................... 60
Table 4-12: Selected Alginate Products Currently on the Market .............................................. 62
Table 4-13: Selected Hydrocolloid Products Currently on the Market ...................................... 65
Table 4-14: Selected Hydrogel Products Currently on the Market ............................................ 72
Selected Films and Composites Currently on the Market ........................................................... 72
Table 4-16: Selected Foam Manufacturers and Products............................................................ 77
Table 4-17: Selected Artificial Skin Products Currently on the Market .................................... 80
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Table 4-18: Selected Collagen Products Currently on the Market ............................................. 83
Table 4-19: Selected Negative Pressure Wound Therapy Products
Currently on the Market ............................................................................................................... 90
Table 4-20: Selected Pressure Relief Equipment Currently Available ....................................... 95
Selected Pressure Relief Equipment Currently Available ........................................................... 96
Table 4-21: Selected Miscellaneous Wound Treatment Manufacturers and Products ........... 105

CHAPTER FIVE: TOTAL MARKET SIZE, FORECAST AND

COMPETITIVE ANALYSIS .......................................................................................................... 
Table 5-1: Total Worldwide Wound Care Market Revenues 2009-2016 ................................. 108
Figure 5-1: The Worldwide Wound Care Market Revenues 2009-2016 .................................. 109
Table 5-2: Worldwide Wound Care Revenues by Segment (Surgical and
Trauma, Skin Ulcers, Burns) 2011 ($millions) .......................................................................... 111
Figure 5-2: Worldwide Wound Care by Segment (Surgical and Trauma,
Skin Ulcers, Burns) ...................................................................................................................... 112
Table 5-3: Total Worldwide Wound Care Market by Region and
Country Breakdown 2011 ........................................................................................................... 114
Figure 5-2: Worldwide Wound Care Revenues by Region, 2011 .............................................. 115
Figure 5-3: Worldwide Wound Care Revenues by Region, 2016 .............................................. 116
Table 5-4: Revenues and Share of Total Worldwide Wound Care Market
by Leading Supplier 2011 ............................................................................................................ 120
Figure 5-4: Market Share by Leading Supplier 2011................................................................. 121
Figure 5-5: Wound Closure Percentage Breakout 2011 by Percent (Collagen Sealants,
Staples, Adhesives, Sutures) ........................................................................................................ 123
Figure 5-6: Wound Management Percentage Breakout 2011 by Percent (Debridement,
Gauze, Tapes, Bandages, Wound Cleansers, Anti-Infectives) ................................................. 124
Figure 5-7: Moist Wound Market Percentage Breakout 2011 by Percent (Foams,
Alginates, Film, Hyrdrogel, Hydrocolloid) ................................................................................ 125
Figure 5-8: Biologic Dressings Percentage Breakout 2011 by Percent .................................... 126
Table 5-5: Market Segment Summary Revenues by Application (Wound Closure,
Wound Management, Moist Dressings, Biologic Dressings,
Pressure Relief NPWT, Misc) 2009-2016 .................................................................................. 127
Figure 5-9: Revenues by Application 2009-2016......................................................................... 128

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CHAPTER SIX: INDUSTRY DEVELOPMENTS 

Table 6-1: World Population by Selected Geographical Region, 2010 - 2050.......................... 131
Figure 6-1: World Population by Selected Geographical Region, 20102050 ......................... 132
Table 6-2: Estimated Mid-year World Population by Age and
Geographical Region, 2011 ......................................................................................................... 133
Figure 6-2: Estimated Mid-year World Population by Age and
Geographical Region, 2011 ........................................................................................................ 133
Table 6-3: Global Prevalence of Wounds by Type ................................................................... 135
Table 6-4: Clinical Trials Using MSC......................................................................................... 155





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Chapter Three: Main Types of Wounds

19

melanin and hemosiderin. When capillaries rupture, red blood cells are released and
disintegrate, with subsequent release of hemosiderin.
The skin texture of the lower leg is leathery, with a characteristic red-brown
appearance. Edema has usually been present for a prolonged period of time. The ulcer
is a concave lesion below the margin of the skin surface and may become extensive.
Pain may occur when the limb is in a dependent position or during ambulation. Pain
is usually relieved by elevation of the foot.
If the ulcer is untreated, the lesion becomes more extensive, eroding wider and
deeper. The likelihood of infection is increased. Scar tissue formation around the rim
of the ulcer is found. Poor hygiene, debilitation, and inadequate nutritional status
contribute to the severity of the ulcerative lesion.
The key to facilitating healing is extrinsic compression to minimize venous stasis,
venous hypertension and edema. Extrinsic compression methods used include
compression gradient stockings, elastic bandages and Unnas boot. The affected limb
should be wrapped with an elastic bandage to provide compression. A dome paste
(Unnas) boot, which hardens into a semirigid cast, is effective at promoting healing
and works especially well as an outpatient therapy. It effectively controls edema and
requires changes only once or twice per week.
Newer therapies, focused on promoting healing in a moist environment, have
been successful. Several adhesive hydrocolloid dressings are currently available, and
when used in conjunction with extrinsic compression, have proved to be effective in
hastening the healing of venous leg ulcers.

BURNS
Thermal Injury
The most common type of burn is thermal injury, which can be caused by
flame, flash, scald, or contact with hot objects. Thermal injury has a severe impact on
the patients cellular and humoral immune systems. The degree of immune
suppression is proportional to the duration and temperature of thermal exposure. The
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78

World Wound Care Markets

ARTIFICIAL SKIN
Several different types of skin and skin replacement products and therapies are
available:
x

Dermal replacements

Epidermal replacements

Skin replacements

Dermal replacements are engineered to support the infiltration, adherence,

proliferation, and neo-matrix production by fibroblasts. Epidermal replacements are
engineered with keratinocytes, aided by a carrier mechanism such as a polymeric film
or bioresorbable matrix. Skin replacements are engineered as a combination of both
keratinocytes and fibroblasts, and are able to support both epidermal and dermal
components.
Further, the engineered skin and skin replacements fall into three categories:
x

Allogenic cells

Autogenic cells

Xenogeneic cells

Allogenic cells are derived from tissue that is transplanted from one person to
another. This approach increases the likelihood of skin graft rejection and disease
transfer. Autogenic cells are derived from tissue that is moved from one part of the
body to another or cells are seeded into the device being constructed and applied back
to the patient. There is little potential for rejection because the tissue is composed of
the patients own skin cells. Xenogeneic cells are derived from tissue that is
transplanted from another species.
Industry Innovations
Healthpoint recently acquired two cell-based technologies from Intercytex
Limited. The therapeutic candidates included in the deal were Cyzact- human dermal
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Chapter Five: Market Summary

127
Table 5-5

Market Segment Summary Revenues by Application

(Wound Closure,Wound Management, Moist Dressings, Biologic Dressings, Pressure Relief NPWT,
Misc) $ millions
2009-2016

Year
2009
2010
2011
2012
2013
2014
2015
2016

Wound
Closure

Years
2009-20011
20011-2016
20092016

Manufacturer Revenue (in millions)

Wound
Moist
Biologic
Pressure
Management
Dressings
Dressings
Relief

Wound
Closure

Wound
Moist
Management Dressings

Misc
NPWT

Total

Growth
Rate

Compound Annual Growth Rate

NPWT
MiscTotal Growth Rate
%
Biologic
Pressure
Dressings
Relief

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