There have great strides in the treatment of wounds and
wound infections with recent advances in technology, however
infections remain responsible for a high rate of mortality.
James Woodburn looks at the history of wound care and at two
complimentary wound care products that are making a comeback
after years in limbo.
treatment of wounds and wound infection is as old as mankind
and yet with all the medical knowledge available to modern
physicians wound infections remain responsible for a
disturbingly high rate of mortality, particularly among
Some of the first documented evidence describing wound
treatments dates back to the ancient Egypt-ians who were the
first civilisation to have trained physicians to treat
physical aliments. Medical papyri, such as the Edwin Smith
papyrus (circa 1600 BC) and the Ebers papyrus (circa 1534
BC), provided detailed information about the management of
disease, including wound management with the application of
various potions and grease to assist healing.
Aulus Cornelius Celsus (circa 25BC-50AD), considered one of
the greatest Roman medical writers, described the four
principal signs of inflammation and recommended cleanliness
and the washing of wounds with antiseptic substances, such
The father of surgery, Claudius Galen (c129-216AD), a Greek
physician to the Roman gladiators, was prolific with over
500 medical treatises to his name. However, much of his work
was later discredited. It was centuries later during the
Renaissance that his ‘pus bonum et laudabile’ (good and
commendable pus) theory, which incorrectly asserted that the
development of pus in a wound was a positive part of the
healing process, was discredited.
In the 19th century physicians developed methods for skin
grafts to cover open non-healing wounds thereby decreasing
the amount of time the wound is exposed to bacteria and
reducing the chance of infection.
By the middle of the 19th century, post-operative sepsis
infection accounted for the death of almost half of the
patients undergoing major surgery
During the 1860’s Joseph Lister (1827-1912), a British
Professor of Surgery, began experimental work with
antisepsis and when Louis Pasteur (1822-1895), a French
bacteriologist, sug-gested in 1865 that decay was caused by
living organisms in the air, which on entering matter caused
it to ferment, Lister made the connection with wound sepsis
revolutionising the entire concept of wound infection. In
1867 Lister placed carbolic acid into open fractures to
sterilise the wound and prevent sepsis and the need for
amputation, until then a common treatment for chronic wound
It was only in the late nineteenth century that ascetic
surgery came into practice with the sterilisation of
instruments and the wearing of gowns, masks, and gloves.
Penicillin first was used clinically in 1940 by Howard
Floery and with the use of antibiotics, a new era in the
management of wound infections began.
However, surgical-site in-fections (SSI) and hospital
acquired infections (HAI) are still a major problem, largely
due to antibiotic-resistant bacteria.
The United States-based Centers for Disease Control and
Prevention (CDC) “Guideline for Prevention of Surgical Site
Infection, 1999,” notes that SSIs are the “third most
frequently reported nosocomial infection, representing 14
per cent to 16 per cent of all nosocomial infections among
hospitalised pa-tients”. The guideline also states that
hospitals in the CDC’s National Nosocomial Infection
Surveillance Sys-tem who conducted SSI surveillance from
1986 to 1996 reported 15,523 (2.6 per cent) SSIs resulting
from 593,344 operations. SSIs were the most common
nosocomial infection among surgery patients, accounting for
38 per cent of infections. Of these, two thirds of the
infections were confined to the incision, with one third
affecting organs or spaces accessed during the operation.
The deaths of 77 per cent of the patients with SSI were
reportedly related to the infection.
“Patients incur a 20-25 per cent increase in costs due to
HAI and SSI. Most of these costs are for nursing care and
hospital overheads,” Dr Osama Beltagi, Franchise Director of
Ethicon, Johnson & Johnson Middle East, points out, adding:
“Simple preventative measures can drastically reduce these
In a study by Leape et al, patients experiencing SSI have
their hospital stay prolonged by 7.3 days on average. The
study notes that SSI’s clearly cause substantial morbidity
and mortality and create a financial burden on healthcare
l Check the CDC Guidelines for SSI and Recommendations for
the Prevention of SSI: www.cdc.gov/ncidod/hip/SSI/SSI.pdf
Demanding better products
As the world’s population ages so is there an expected
increase in the incidence of chronic wounds, which is
fuelling the demand for in-novative wound-care products.
According to recent analysis by Frost & Sullivan the US$1.1
billion Euro-pean wound-care market is slated to grow at an
annual average of 10-12 per cent over the next five years.
Similar to the United States, the demand for wound-care
products is expected to increasingly swing from traditional
to advanced dressings and treatments.
Minakshi Krishnan, Re-search Analyst for Frost & Sullivan
notes that “an aging population, advancement in technology,
emphasis on efficient healing methods and in-creasing
patient awareness are keen drivers for the advanced wound-
Dr Beltagi says in the Middle East the demand for innovative
wound care products is growing rapidly and gives as an
example one of Ethicon’s new products, Promogran - a
treatment for chronic and acute wounds. Launched in the
region last October, he says sales have grown 50 per cent in
He points out that although these products may be more
expensive than the traditional ones, healthcare institutions
and patients will save money in the long term as the new
treatments heal wounds faster, meaning patients spend less
time in hospital and can return to families and work sooner.