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Chronic Wounds and Lymphedema: Neglected areas of public health

The management of diseases and conditions such as diabetes mellitus, venous ulceration, pressure ulcers, traumatic wounds and AIDS related wounds, have benefited from improved medical knowledge and technology leading to better care and reduction in both the morbidity and economic burden.

Additionally, it is anticipated that utilizing modern wound care methods for wounds related to leprosy, Buruli ulcer, trauma and common tropical ulcers, will also lead to significant benefits.

Epidemiology

The precise global burden of chronic wounds and lymphedema is not known. International statistics giving the full picture of the prevalence, disability, and impairment of wounds, burns and lymphedema are difficult to acquire. The aetiologies of these conditions are numerous with regional, national and local specificities.

However, the epidemiology and economic burden of the chronic wound is well documented in the developed world.  Each year, in North America, between five and seven million chronic and/or complex wounds occur. A recent study in the UK showed a prevalence of patients with a wound was 3.55 per 1000 population. The majority of wounds were surgical/trauma (48%), leg/foot (28%) and pressure ulcers (21%). Prevalence of wounds among hospital inpatients was 30.7%. The etiology of these wounds included systemic conditions such as diabetes, atherosclerosis, tuberculosis, leprosy, venous ulcers, pressure ulcers, vasculitis and trauma.

Economic impact & Social impact

Over 9-12 million of the USA population suffer from chronic ulceration each year at cost to the healthcare system $28 Billion annually. Treatment costs for individual venous ulcerations have been reported to range between $957.99 to $1352.00 per ulcer with higher costs for the treatment of complicated ulcers ($9,685.00) Expenses are not limited to the cost of ulcer care, but include other indirect costs associated with disability and lost work days.  Chronic leg wounds in the USA account for the estimated loss of two million workdays per year.  In many cases, a disabling wound results in the loss of two or more people from the work force—the patient and the person caring for the patient.

Limited access to modern technology for managing chronic wounds and lymphedema in developing countries

Advances in modern wound and lymphedema management have occurred mainly in the developed world. In the developing countries however, outdated techniques, practices and materials are used managing these conditions thus leading to prolonged morbidity, suffering and high costs. For example observations throughout the world have shown common mis-management deficiencies.
Standard wound care most often is reduced to tissue toxic cleansing solutions, misuse of topical antibiotics, wet to dry gauze dressings and the absence of compression bandaging. Management of lymphedema, filiriasis in particular, often demonstrates a lack of basic hygiene and absence of compression bandaging. This scenario too often results in severe disability, isolation, and in far too many cases, amputation. In these countries, recycling of dressings and bandages are common and frequent changes of dressings are not done as often as needed because of limited availability of materials or costs.

Acting together to end neglect and unacceptable suffering

The education philosophy of WAWLC strives to "teach the teachers" optimizing local clinicians and integration into the existing healthcare structure.
It is intended that such care be provided in a cost effective manner utilizing, where possible, locally available products and currently available essential drugs and dressing supplies. The teaching and training programs will include the use of therapies common to multiple disciplines. It is believed that significant benefit will be achieved by decreasing now prevalent, ineffective, costly remedies. Experience has shown that misdiagnoses and lack of understanding of the principles of modern wound and lymphoedema care can be devastating to the overall health and economic welfare of all communities.