Because of the tremendous resources they require to heal, patients with severe wounds present significant challenges to our healthcare system. This study was undertaken to introduce the concept of "wound burden" and its predictive value in anticipating the costs associated with inpatient care for patients with wounds. Wound burden is a new concept that can be used to represent the severity of a patient's skin breakdown; it is defined in this study in terms of number, size, and stage. A computerized system of wound cost tracking measured the costs involved in delivering optimal wound care to 240 patients in a long-term acute care facility. Patients were stratified in a system that accounted for "wound burden" to determine the degree to which wound burden is related to costs. Costs that pertained to supplies, specialty beds, nutrition, labs, and extra personnel time required to document and care for the wounds were recorded. The concept of "wound burden" was presented and found to be very important in predicting actual costs. Patients with the highest level of wound burden were found to have significantly higher wound costs and total stay costs (P > 0.0001). As payment systems change, having data available to justify the resources necessary to allow facilities to continue to care for the most highly wound burdened patients will become increasingly important.