On a typical Monday morning at Fairview Southdale's Institute for Wound Healing, the white board in the back hall is filled with the first names of patients who are waiting to see William Omlie, M.D.

A nurse has already removed their dressings, measured and photographed the wounds and, where necessary, placed a temporary bandage to sop up the drainage. Before removing those, Omlie, a vascular surgeon, will slide a bucket up to the edge of the exam table.

Like the patients who bear them, the wounds are all different shapes and sizes. One diminutive, elderly woman has a wound the size of a bar of soap on her calf that looks raw and painful. But she doesn't even flinch as Omlie sets a scalpel, which resembles an X-acto knife, at the edge of the wound and begins to scrape its surface.

"She's tough," he says. She can feel it. Unlike many of Omlie's other patients, her nerves are not impaired. The diabetic man, in the next room, for example, had no idea that as he strolled the beach in a pair of sandals, he had worn a hole in his big toe about as wide and as deep as a stack of three quarters.

Omlie's patients — and millions of Americans like them — have created one of health care's fastest-growing markets: wound care. Driven by the surging number of Americans who are diabetic, obese or geriatric, wound care services and products are in high demand.

Wounds can't heal properly without good nutrition, good circulation and a healthy nervous system, three things obese, diabetic or geriatric patients often lack.

Twin Cities wound care clinics proliferating
In the Twin Cities, every major hospital system now operates a wound care clinic that provides wound management on an outpatient basis. Statewide, the number of wound management programs provided by hospitals increased from 34 in 2002 to 60 in 2005, according to the most recent survey data available from the Minnesota Hospital Association. Several more have opened since.

Some hospitals use hyperbaric chambers to speed healing by getting increased oxygen to the wound. During treatment, patients enter a chamber of increased atmospheric pressure and breathe 100 percent oxygen.

Hennepin County Medical Center in Minneapolis and the Mayo Clinic in Rochester both have hyperbaric chambers that are used to treat a variety of ailments, including chronic bone infections, crush injuries, carbon monoxide poisoning, skin grafts and chronic wounds.

"Our business has increased 100 percent over the last seven years," says Jan Derouche, nurse manager of HCMC's hyperbaric medicine department, which draws patients from all over the Midwest. Most have injuries stemming from radiation treatment for cancer, she says, but an increasing number have diabetic ulcers.

Not all wounds can benefit from hyperbaric treatment, Derouche says. Treatment for those that can is a big commitment. Patients need a two-hour treatment five days a week for six to eight weeks. Some insurers offer coverage for a portion of the cost, which totals $35,000. Without hyperbarics, outpatient treatment, including two weekly visits, runs about $20,000 and can take months or years.

Outpatient wound care fills the service gap between in-home and inpatient care. To qualify for in-home wound care, a patient needs to be immobile. Inpatient treatment is reserved for the most severe wounds. The majority of patients with serious, chronic wounds falls somewhere in between. And their numbers are increasing.

Consider:

· Nearly 21 million Americans have diabetes. In the United States, a new case is diagnosed every 30 seconds.

· Obesity rates for American adults have doubled since 1980.

· About 60 million adults, or 30 percent of the adult population, are obese, meaning their body mass index is greater than 30.

· Another 60 million are considered overweight, with a BMI of 25 to 29.9.

· Since 1980, overweight rates have doubled for children and tripled for adolescents.

· Since 1990, the number of Americans who are 65 or older has increased 12 percent to 35 million people. That number is expected to double by 2030, as baby boomers begin turning 65 in 2011.

· More than 10 million people 60 or older have diabetes.

Diabetes care costs growing rapidly
As these segments of the population increase, so does the cost of providing health care for them. With an annual bill topping $132 billion, diabetes already accounts for at least one of every 10 dollars spent on health care. And obesity-related health care costs are gaining fast, totaling more than $75 billion annually.

By 2009, the wound care market could exceed $11.8 billion, according to Ron Sills, an analyst with Nerac, a research and consulting firm in Tolland, Conn. The market includes: wound vacuums, wound closure strips, staples, skin graft materials and bandages.

One piece of the market where profit margins are extremely low and sometimes nonexistent is the provider end. The doctors and nurses who attend to this messy business don't receive big payments from insurers in exchange for the care they provide.

In fact, Fairview Southdale closed a wound care clinic it ran for 12 years starting in 1989 for financial reasons. But the patients didn't go away. They multiplied. And because their primary care physicians don't have the time to manage their chronic wounds, many of them ended up in the hospital for inpatient treatment which can cost $100,000.

So, in February 2006, Fairview Southdale opened its Institute for Wound Healing. The 16-person staff includes nine nurses, a plastic surgeon, a general surgeon, a vascular surgeon, three podiatrists and an infectious disease specialist.

"We saw 600 new patients in 2006," says Pat Hepner, patient care coordinator and a registered nurse who has been tending wounds since the first clinic opened in 1989.

A lot has changed in 18 years, she says, the technologies, the products. There are fewer amputations now. As for the patients, the good news is that not as many of them smoke, the bad news is they're younger and bigger.

She, Omlie and the other staff members perform a delicate choreography in the back hall as they enter and exit the exam rooms. On this typical Monday, they are short one person and the waiting room is full.

Carla Solberg reports on local business developments, the health care industry and other topics. She can be reached at carlasolberg [at] msn [dot] com.