If you had to bet, what are the biggest financial burdens on the NHS? You can likely guess some: cancer, dementia, mental health. But while each lung cancer patient costs healthcare more than £9,000 annually, and the pressures of dementia rise with an ageing population, the country’s politicians typically neglect another, no less intense, strain on the national health service: chronic wounds. Sparked by a range of different conditions, from fungal infections to cardiovascular issues, what’s indisputable is their effect on Britain’s collective purse. As far back as 2017–8, after all, doctors and nurses were treating some 3.4 million wound patients each year. Altogether, these procedures cost the taxpayers £3.8bn.
Nor, of course, are chronic wounds merely a monetary concern. Once again, the statistics are stark, with ulcers preceding some 85% of limb amputations, even as non-healing diabetic wounds globally oblige doctors to remove a patient’s arm or leg every 30 seconds. And while techniques to mitigate against these dangers certainly exist, they’ve traditionally been exhausting for patients and nurses alike. As Mamun Rabbani, a PhD student at City, University of London and member of the Targeted Therapy Technology (3T) Group puts it: “In the case of chronic or complex wounds the use of conventional methods requires constant and lengthy care adding to the time and resource burden of the NHS.”
The City, University of London researcher is certainly not wrong in what he’s saying. From changing dressings to keeping wounds dry, it’s estimated that a single diabetic ulcer costs $50,000 a year to treat, even as medical professionals are kept from more productive tasks. Yet now, together with colleagues at City, Rabbani is investigating a solution. Alongside a host of other global researchers, he’s using the power of electrical stimulation to heal chronic wounds, using the current to encourage the body to fix itself. It goes without saying that the consequences here could be revolutionary – if, that is, the devices involved are developed with sensitivity and care.
Not just flesh wounds
Sparked by everything from pressure injuries and burns to simple cuts, wounds are a common feature of medical life. But chronic wounds are different. Gaining that dubious distinction if they don’t heal in orderly stages, or else remain unresolved for more than three months, they can be truly debilitating. That’s especially true, explains Dr Robin Martin scientific consultant on wound healing and reconstructive surgery, given most chronic wounds aren’t found in hospitals. “Apart from certain interventions,” explains the wound expert and consultant, “most provide a big burden on community health care systems.” This makes sense: by definition long-lasting, the health service can’t possibly treat every wound in-house. Yet if they’re out of sight, chronic wounds are certainly not out of mind, requiring frequent visits from nurses and other experts. That’s inevitably expensive. Quite aside from the NHS’s outlay, one 2014 study found that wound care for US Medicare recipients cost anywhere from $28bn to $96bn.
$28bn
The minimum estimated cost of wound care for US Medicare recipients. The upper estimate is $96bn.
AAFP
It doesn’t help, meanwhile, that the treatment of chronic wounds traditionally tends to focus more on mitigation rather than cure. Though there are plenty of techniques available here – cleaning and dressing; antimicrobial washes; removing dead or inflamed tissue in a process called debridement – they’re all basically aimed at keeping a wound stable. But what about actually fixing the underlying problem? Until recently, medical professionals were stumped. Over the past few years, however, they’ve started exploring the uses of electrical stimulation. Exploiting the same pulses the body uses to heal independently (known as ‘endogenous bioelectricity’), doctors can use current to focus cells, encouraging them to proliferate in certain parts of the body, or else prod them in particular directions. Ideally, electrical stimulation should also combat infection, destroying microbes in a wound while preserving the harmless tissue below.
To be clear, this technology is not entirely novel, with doctors having been aware of its potential since the 1960s. The problem, suggests Dr Iasonas Triantis, co-lead of the 3T Group at City, is that the electrical stimulation strategy and set-up used in applications like TENS or physiotherapy, often used in wound care studies, aren’t necessarily suitable for healing chronic wounds. For Martin, slow adoption can equally be understood by medical philosophy. Because electrical stimulation is an invisible process, he suggests that many doctors saw it as “magical and mystical” – and were understandably sceptical of the process. Another challenge has typically been electrical stimulation devices themselves. Cumbersome and complex, they’re hardly suited to cramped hospital wards, even less so for flying home visits.
Bringing wounds to heal
If you want to get a sense of how far electrical stimulation has come, you could do worse than buy an Accel-Heal Solo. Developed by a team in Kent, these electrode pads are little bigger than plasters – nor much more complicated. Applied to a wound much like a regular dressing, the current is supplied via a small plastic box. Turning on the machine is as simple as clicking the ‘start’ button, even as the system is sophisticated enough to monitor current flow, adjusting voltage as necessary. The few wires the Accel-Heal Solo does require can easily be wrapped around a patient’s body, ensuring they remain mobile during use. Not that treatment is needed for long: according to the device’s manufacturer, a 12-day treatment programme is enough to stimulate healing.
12
Number of days needed for a Accel- Heal Solo treatment programme, lower than more traditional techniques.
Accel Heal
Martin, who’s worked with Accel-Heal on developing their technology, is unsurprisingly excited about these developments. Unlike larger devices mounted on trolleys, he believes that disposable machines like the Accel-Heal Solo offer a “useful business model” for combating chronic wounds. Fair enough, particularly if you examine the sector more broadly. As work by Precision Business Insights found, the advanced wound care market is already worth more than $10bn, and is expected to enjoy CAGR of 6.6% through the end of the decade. That’s echoed by the success of specific companies. In France, for instance, WoundEL has developed a robust wound-healing platform weighing just 600g. Across the Channel, Natrox is a Cambridge manufacturer that’s won industry awards for its own electronic therapy work.
Four times How much more likely venous leg ulcers are to occur in patients over 80 than in their slightly younger cousins.
NCBI
This excitement isn’t hard to understand. As a stroke, these bijou technologies promise to put treatment into the hands of patients themselves, even as alleviation is abandoned for cures. That’s clear enough if you examine the Accel-Heal Solo, with Martin noting that the “rate of risk of good clinical response” is about 80%. Not, of course, that electric stimulation is a panacea. As Martin continues, doctors can’t expect to abandon traditional treatment options – and should instead integrate machines like the Accel-Heal Solo into regular cleaning and debridement cycles. “Bioelectricity doesn’t outweigh all the other things,” he says. “But it’s just been an elephant in the room that we’ve been missing.”
Old age problems
At City, Triantis and Rabbani stress difficulties around understanding exactly how electrobiomodulation therapy works. Fortunately, doctors are now convinced of its potential. But with so many variables at play – from the location of the wound and the type of tissue involved to electrical parameters and where electrodes are placed – Triantis says particular set-ups can have a “very specific effect.” Once you factor in different types of wounds, from pressure ulcers to abrasions, it can be achievable to create a platform flexible enough to work across healthcare. That’s obvious even for successful applications. The Accel- Heal Solo may help cure some 80% of wounds, but Martin admits that “we’re not really sure why the 20% don’t give such a good response”.
How can these hurdles be overcome? One option is to not merely envisage medical devices as a machine – but appreciate they’ll be used by flesh-and-blood patients. As Rabbani puts it: “That’s why you always need a biologist on board when you’re designing medical devices.” Notwithstanding the relative adaptability of platforms like the Accel-Heal Solo, designed to combat pressure ulcers, diabetic foot ulcers and more, another option involves building electrical therapy around specific wound types. Dr Michael Powner, the other co-lead of the 3T Group, gives the example of venous ulcers. “These are one kind of ulcer, a wound, that we can target. Finding the parameters for one type of ulcer is then a starting point to treat other ulcer types,” he says, adding all injuries of this sort primarily affect the epithelial cells, and the tissue just below, on the surface of the body.
What’s not in doubt, is that demand for such treatments will rise. Demographically, it’s a near certainty, with data in the UK’s General Practice Research Database showing venous leg ulcers are as much as four times more likely to form in patients over 80 than slightly younger cousins. No wonder insiders expect the market for dynamic electrical stimulation to grow. “I think it’s very important,” says Martin, “to evaluate newer technologies that can be applied at relatively low cost to patients in their own homes – without needing specialist intervention.” Considering both the need for effective chronic wound treatment, and the potential of electrical stimulation as a solution, it’s hard to disagree.
