By Windy Cole, DPM, CWSP
Treating hard-to-heal wounds can be extremely challenging. Emerging theragnostic technologies entering into the space have the potential to transform how wound care is delivered. Presently, wound care assessment and monitoring is quite subjective and may vary from clinician to clinician. Most commonly, visual inspection and manual measurements are used to assess wound progress. Wound inspections typically require dressing removal and may result in suboptimal dressing change frequency, increased clinical inspection time, patient discomfort, and increased cost of wasted dressings. When indicated, clinicians may employ the use of cultures, biopsies, and other laboratory tests, but those studies take time to process and may cause a delay in treatment. In essence, we are often practicing ‘reactive’ wound care. It would therefore stand to reason that a more proactive method of wound assessment that could provide clinicians better quantitative data in a timely way may be extremely helpful. In the near future, a host of “smart” bandage options may be able to do just that.
The intended function of standard bandage materials is to provide a moist wound healing environment and promote wound healing while also serving as protection against contamination. A “smart” bandage would perform these functions plus a whole lot more. Research is currently underway on several different bandage systems containing embedded sensors that can wirelessly communicate various valuable wound parameters. These products can autonomously monitor both the condition of the wound and the dressing itself. This information will give clinicians a real-time quantitative view into the wound environment and will help facilitate more expedient and personalized wound care therapies. Some of the specific wound parameters that could potentially be monitored include:
PH: PH plays a vital role in wound healing. Measuring PH levels could play a significant role in early identification of non-healing wounds. Healing or acute wounds tend to operate in a slightly acidic environment, typically in the 5 – 6 PH range. In contrast, hard-to-heal or chronic wounds exhibit PH ranges between 7 – 9. This is thought to be in part due to increased levels of bacteria. Large changes in PH could therefore serve as an early alarm to the potential for wound infection.
Exudate: Key quantitative data such as exudate quality, volume, rate, and dressing saturation could help clinicians and patients eliminate unnecessary dressing changes and has the potential to decrease patient discomfort and overall healthcare costs. Very dry or very wet wound environments will hinder healing. Smart dressings that contain saturation indicators or moisture mapping have the potential to help decrease patient morbidity while promoting wound healing.
Temperature: Most cellular functions are affected by temperature. Increased and prolonged temperatures in a chronic wound can indicate inflammation and be a sign of bacterial infection. If infrared thermography could be incorporated into smart bandage systems to continuously monitor wound temperature, it may serve as an expedited method of detecting wound infection.
Oxygen: Oxygen plays a key role in all stages of wound healing. Without adequate oxygen levels, wound healing becomes impaired. Studies have shown that the partial pressure of O2 in the exudate of a non-healing wound is 5mmHg – 20mmHg compared to 30mmHg – 50mmHg seen in healthy tissues. Smart dressings that can monitor cutaneous oxygen have real potential application in wearables.
“Smart” dressings also have the potential of delivering medication or treatments with minimal invasiveness. A team at the VA Health System in Cleveland, Ohio, is working on a “smart” bandage that contains both a microchip and sensors that utilize electrical stimulation to treat chronic wounds. The bandage can stay in place for up to 7 days. The hope is that in the future this smart bandage may sync up to the patient’s phone and directly transmit this information to the patient and their healthcare provider allowing for real-time treatment adjustments. The therapy could be delivered remotely through the bandage as to not disturb the wound dressing. There is also potential to decrease the frequency of out-patient wound clinic visits.
While there are a number of “smart dressings” in development and several prototypes undergoing preliminary testing on humans, there are none available for commercial use at this writing. The challenge seems to be producing a wearable monitoring dressing that contains the technical components, but remains cost effective and practical. The current focus is on the development of miniaturized sensing apparatuses that are able to wirelessly transmit data using only minimal power. To be widely accepted by wound care patients and clinicians these bandages must be comfortable, low profile, long-wearing, biocompatible, disposable and easy to use.
There is significant potential for these emerging “smart” bandages in the field of wound healing. Monitoring devices that can help guide clinicians to develop the best treatment plans based on data collected in real time could be a real game changer. There remain several hurdles that will need to be overcome such as developing low-power, low-cost and flexible electronic sensors that are not disrupted by biochemical waste or wound exudate. Keep your eyes out for these next generation of smart wound monitoring technologies. With the potential to objectively measure biomarkers and assist in effective treatment delivery, these “smart” bandages may indeed be the future of wound care.
Windy Cole, DPM, CWSP, serves as Adjunct Professor and Director of Wound Care Research at Kent State University College of Podiatric Medicine and Student Rotation Coordinator, UH Richmond Medical Wound Center, both in Cleveland, Ohio. She is a dedicated healthcare advocate with interests focused on medical education, diabetic foot care, wound care, limb salvage, clinical research, and humanitarian efforts. Dr. Cole has published extensively on these topics and is a sought-after speaker both nationally and internationally. Dr. Cole also serves as a member of the Editorial Advisory Board for LER.
- O’Callaghan S, Galvin P, O’Mahony C, Moore Z, Derwin R. ‘Smart’ wound dressings for advanced wound care: a review. J Wound Care. 2020 Jul 2;29(7):394-406.