Chronic wounds, such as diabetic ulcers, surgical wounds, pressure injuries, and other issues, have a higher mortality rate than many people realize. The five-year survival rate for patients with chronic wounds is approximately 70%, which is worse than that of breast cancer, prostate cancer, and other severe diseases. The treatment of wounds is also costly.
A group of researchers from the Keck School of Medicine of USC and the California Institute of Technology (Caltech) is working on a range of advanced technologies to transform wound care. This includes the development of smart bandages designed to automatically detect and respond to changes in a wound’s conditions. These advanced dressings would continuously provide data on the healing process and potential complications, such as infections or abnormal inflammation, and could deliver medications or other treatments in real-time.
Partially funded by the National Institutes of Health, a smart bandage has been created and trialed by the USC-Caltech team in animal models as part of a proof-of-concept study.
“We’re creating a new kind of ‘cyber skin’ that can help these wounds heal while measuring and managing them along the way,” said co-senior author David G. Armstrong, PhD, DPM, a professor of surgery and neurological surgery at the Keck School of Medicine and co-director of the Southwestern Academic Limb Salvage Alliance (SALSA). “This paper combines these recent insights to chart a way forward in the wound healing space so that we can move quickly to help our patients recover.”
Armstrong and his team have utilized advancements in materials science, nanotechnology, and digital health to enhance smart bandage technology. Recent improvements in wound healing research funding and the regulatory approval process have also facilitated progress.
“We have been developing next-generation smart bandages that can wirelessly monitor crucial metabolic and inflammatory biomarkers in wound fluids,” said Wei Gao, PhD, an assistant professor of medical engineering at Caltech and co-senior author of the paper. “Going forward, these interdisciplinary collaborations among scientists, engineers, and clinical experts—with patients at the center—will play a crucial role in better wound care outcomes.”
Acute wounds follow a typical path of injury, inflammation, and healing, while chronic wounds are more intricate and unpredictable. They pose a greater risk of infection, take longer to heal, and could result in amputation or severe complications like sepsis.
One potential solution is the implementation of new smart bandage technology, which can assist and even actively engage in the healing process. Clinicians may potentially replace passive dressings with wireless technology that can detect inflammation, infections, or issues with blood flow in a patient’s wound. This technology can alert both patients and healthcare providers through Bluetooth while providing real-time treatment. Armstrong and his team have conducted successful tests with this new technology in animal models.
“This closed-loop system can identify a problem, diagnose it automatically, and deliver a solution, all with patient and clinician oversight,” he said.
Smart bandages are constructed using various state-of-the-art materials, such as bioelectronic materials, which aid in healing by delivering electrical stimulation to tissues and cells. Many of these bandages utilize advanced hydrogels, which are soft, flexible, and have the capacity to store and release drugs in response to pH, temperature, and other environmental factors.
The next generation of smart bandages incorporate different types of sensors to identify changes in the wound microenvironment. Electrochemical sensors measure proteins, antibodies, nutrients, and electrolytes, while optical sensors oversee temperature, pH, and oxygen levels. Imaging sensors like photography, ultrasound, and fluorescence imaging can identify bacterial infections and measure the depth and volume of a wound to track healing progress.
In a review of new technologies, the researchers highlight various challenges that need to be addressed before smart bandages can become standard in medical practice. Many medical systems currently use outdated methods for wound care, such as visually assessing and categorizing wounds without standardized criteria. As a result, integrating smart bandages would necessitate a significant overhaul of the field’s existing standards.
“While the idea of a dressing that would help us how we need when we need it makes sense to us, it also has to make sense to our colleagues at the FDA,” Armstrong said.
Gaining approval from the FDA for smart bandages is a complex process involving the collection of a substantial amount of preclinical and clinical data by the USC-Caltech research team. The FDA provides flexibility for wound care products combining multiple therapies but requires special approval, making data collection crucial.
Smart bandage data can be swiftly processed and analyzed using machine learning tools, allowing for efficient wound monitoring and care, whether at the doctor’s office or remotely. Armstrong compared this new approach to the early detection of high cholesterol for the treatment of heart disease with a statin.
“What’s amazing is that in wound healing, we haven’t been using those interim measures. All we’ve done is the equivalent of measuring someone in the middle of a heart attack,” he said. “Developing these interim companion diagnostics is critical.”
Enhancing wound care responsiveness is crucial not only for saving lives but also for enhancing the quality of life for numerous patients. Approximately half of individuals with chronic wounds satisfy the diagnostic criteria for clinical depression, and many encounter significant difficulties with mobility, pain, and wound management on a daily basis.
Armstrong expressed the desire to optimize the number of days without ulcers, hospital visits, and full activity for our patients.
Following this, Armstrong and his team are investigating a novel method of wound care utilizing ultrasound technology to assist in administering gene therapy treatment. The objective is to promote the growth of blood vessels in calf muscles, potentially reducing the risk of amputation in patients with leg ulcers.
Journal reference:
- Canran Wang, Ehsan Shirzaei Sani, Chia-Ding Shih, Chwee Teck Lim, Joseph Wang, David G. Armstrong & Wei Gao. Wound management materials and technologies from bench to bedside and beyond. Nature Reviews Materials, 2024; DOI: 10.1038/s41578-024-00693-y
