Advice

The technology

The technology

WoundExpress (Huntleigh) is an advanced wound therapy device, which uses intermittent pneumatic compression to promote lower leg wound healing for people at home. The device has a specially designed 3‑chamber garment that attaches to a pump, which has a patented timing cycle to augment venous and arterial blood flow. By inflating the garment in this special sequence, the company says that the flow of nutrient and oxygen-rich blood increases into the affected region, helping with wound healing.

Innovations

The company claims WoundExpress is unique because it's designed to go on the thigh of the ulcerated limb, rather than the wound site. Intermittent pneumatic compression is widely used, but the company claims this novel approach to positioning has the benefit of increasing arterial and venous circulation to the wound site without applying direct pressure to the wound bed.

Current care pathway

WoundExpress is intended to be used alongside standard care for hard to heal lower limb venous and mixed aetiology ulcers. Standard care involves cleaning and dressing the wounds with static compression therapy (bandages, or hosiery). The best dressing to use depends on things like wound size and depth, and amount of exudate.

More complicated wounds, for example surgical site infections, diabetic foot problems, venous leg ulcers and pressure ulcers can result in chronic non-healing wounds and need more advanced care. Care of these types of wounds aims to promote healing and minimise the risk of further complications.

A professional with expertise in wound management (such as a district nurse or tissue viability nurse) should be involved in the person's holistic assessment. For venous leg ulcers this should include a general wound assessment, limb and vascular assessment, venous assessment and wound and surrounding skin assessment.

Vascular assessment can, using ankle brachial pressure index, identify whether arterial disease is present and so if compression therapy is appropriate. Before starting compression therapy, dressing choice is decided: compression bandages or hosiery. The amount of compression may vary, depending on what caused the wound.

The following publications have been identified as relevant to this care pathway:

Population, setting and intended user

WoundExpress is intended to be used alongside current wound treatment. It can be used to treat hard to heal lower limb venous and mixed aetiology ulcers that are not progressing significantly towards healing in people over 18.

WoundExpress is not appropriate for suspected deep vein thrombosis, pulmonary embolism, thrombophlebitis, severe congestive cardiac failure, symptoms of sepsis, pulmonary oedema associated with significant limb oedema, active metastatic disease affecting the limb, kidney failure, acute infections of the skin such as cellulitis, severe acute or chronic limb-threatening ischaemia and severe peripheral artery disease (ankle brachial pressure index of 0.6 or less).

WoundExpress is applied at home by the user for a total of 2 hours every day. People who have problems with dexterity or cognitive impairment may need a family member or carer to help them put it on. People may need some basic advice on how to use the technology.

Costs

Technology costs

Standard care using wound dressing and static compression therapy is expected to take place before and alongside WoundExpress.

  • WoundExpress pump: £90 per week rental (quantity and duration discounts may apply). The pump has an expected lifecycle of up to 7 years. It needs to be serviced every 2 years, which costs £106.

  • Single patient garment: £195, single patient use, guaranteed to last up to 16 weeks of daily use.

  • In total WoundExpress costs £114 per week, including disposables and service, based on the recommended 8‑week rental period.

Costs of standard care

Different dressings are available for standard care of non-healing wounds. Individual dressing costs are:

  • soft polymer dressing £3.49 to £17.91

  • hydrocolloid fibrous dressing £0.99 to £10.58

  • antimicrobial dressing £0.18 to £48.08

  • if appropriate, PICO negative pressure wound dressing kits cost between £20.15 to £129.60

  • high compression bandages £2.52 to £6.24

  • multilayer compression bandaging (Ultra Four, Profore) £4.19 to £12.38.

Chronic wound treatment is not a single treatment. It is a treatment process over time. Total wound care costs over a year are reported as £698 to £3,998 per person for a healed wound, and £1,719 to £5,976 per person for an unhealed wound (Guest et al. 2017; Andriessen and Eberlein 2008). The annual cost of a venous ulcer is reported as £3,000 per person for a healed ulcer, and up to £13,500 per person for an unhealed venous leg ulcer (Guest et al. 2018).

Resource consequences

The company estimates that around 265,000 people per year could be eligible for the technology in the UK (based on Guest et al. 2020). WoundExpress is to be used alongside standard care for hard to heal wounds, so initial costs are higher than standard care. However, the company claims that, because it improves healing outcomes, it reduces the resource burden of chronic non-healing and complex wounds. The company says WoundExpress does this by improving healing, reducing length of care and the need for further interventions, improving service efficiency, and potentially allowing resources to be reallocated.

Because the technology is used alongside standard care, organisational changes are not likely to be needed. Healthcare professionals using WoundExpress are trained by the company for free, although there will be a cost for staff time when they are introduced to it. The device is sent with clear instructions and there is comprehensive support online. It can be managed at home by people and carers. The person will need a power source near to where they have their treatment in their home. Appropriate storage of the device and its parts needs to be taken into account, as well as its delivery and return between user and clinic.