Smart Dual-Sensor Wound Dressing for Monitoring Cutaneous Wounds

Smart bandages for wound monitoring and treatment

Wound management plays a crucial role in nursing care as it facilitates effective wound healing and prevents infections. To overcome limitations associated with traditional treatment methods, various smart bandages have been developed. The monitoring of wound parameters and the implementation of targeted treatments are crucial aspects of smart bandage development. Smart bandages, as cutting-edge flexible wearable medical devices, integrate various sensing technologies, providing new insights for dynamic monitoring and personalized treatment of chronic wounds. This paper systematically summarizes the applications and developments of smart bandages in monitoring wound environmental parameters, focusing on two major detection methods: colorimetric sensing and electrochemical sensing. Colorimetric sensors typically rely on color changes induced by physiological parameters, which can not only be identified by the naked eye but also combined with image recognition algorithms for physiological parameter detection. Electrochemical sensors, on the other hand, modify electrodes with specific enzymes and detect physiological parameters through the electrical signals generated by redox reactions. In addition to sensing, this paper further explores the integrated application of three smart therapeutic strategies in smart bandages, including promoting cell proliferation and angiogenesis through electrical stimulation, achieving controlled drug release via responsive materials, and utilizing photothermal materials for efficient antibacterial treatment of wounds. Finally, the paper delves into the challenges these bandages face in system integration and clinical translation, and discusses their potential in personalized wound care.

Volatile organic compounds (VOCs) detection for the identification of bacterial infections in clinical wound samples

Early detection of wound infections is critical for timely intervention and prevention of possible complications since prompt treatment can help lower pathogen spread and enhance faster healing. Early detection also helps reduce the risk of serious infections requiring extensive medical interventions or life-threatening diseases such as sepsis. Culture-based approaches currently used for bacterial identification have limited sensitivity and specificity. At the same time, they are time-consuming, resulting in delays in therapy and, therefore, having a negative impact on the treatment outcomes. Quantifying the volatile organic compounds (VOCs) released by bacteria residing in wounds is a promising, non-invasive option for detecting infections at early stages. This method allows for continuous monitoring without requiring invasive procedures, thereby reducing patient discomfort and the risk of further complications. Spectroscopy methods and sensors are the primary VOC detection and quantification approaches, but sensors are more rapid, cost-effective, non-invasive, and precise. This review highlights the significance of the early detection of wound infection to enable timely intervention and prevent complications, emphasizing the limitations of culture-based approaches. It also explores the potential of quantifying VOCs using different methods and discusses the correlation between their levels and the rate of bacterial infections in wounds. Additionally, the review evaluates current VOC-based monitoring methods for wound management, identifies gaps in the field, and advocates for further research to advance wound care and enhance patient outcomes.

NIR-Induced Power-Effective Smart Bandage for Wound Infection Monitoring and Accelerated Healing

An advanced bandage integrating sensing and therapeutic components for effective physiological monitoring and treatment presents promising potential for chronic wound healing. However, functional components in most bandages are integrated by wires, limiting the wearer's comfort of a soft-hard interface. Herein, a biocompatible smart flexible bandage, containing a reduced graphene oxide/polyacrylamide hydrogel (rGO/PAM Gel) therapeutic dressing and Au/rGO modified biosensor, has been designed. Owing to the photothermal capability of rGO/PAM Gel, the local temperature of the bandage significantly increased under NIR irradiation. High temperature accelerates infected wound healing by killing bacteria, while the bandage sensors enhance biomarker detection. Enriched target molecules and enhanced photo-electrocatalytic activity acquire high sensing performance. Moreover, in situ animal studies demonstrate that a smart wearable bandage could effectively monitor wound exudate biomarkers (i.e., uric acid) and accelerate healing with maximum light energy efficiency. This work provides a power-efficient approach to facilitate the immediate clinical intervention of wound care management.

A review on smart dressings with advanced features

Wound care is a multifaceted and collaborative process, and chronic wounds can have significant repercussions on a patient's well-being and impose a financial burden on the healthcare industry. While traditional wound dressings can effectively facilitate healing, their limitations in addressing the intricacies of the wound healing process remain a formidable obstacle. Smart wound dressings have emerged as a promising solution to tackle this challenge, offering numerous advantages over conventional dressings, such as real-time monitoring of wound healing and enhanced wound care management. These advanced medical dressings incorporate microelectronic sensors that can monitor the wound environment and provide timely interventions for accelerated and comprehensive healing. Furthermore, advancements in drug delivery systems have enabled real-time monitoring, targeted therapy, and controlled release of medications. Smart wound dressings exhibit versatility, as they are available in various forms and can be utilised for treating different types of acute or chronic wounds. Ultimately, the development of innovative wound care technologies and treatments plays a vital role in addressing the complexities presented by wounds and enhancing patients' quality of life. This review sheds light on the diverse types of smart dressings and their distinctive features, emphasising their potential in advancing the field of wound care.

Self-Maintainable Electronic Materials with Skin-Like Characteristics Enabled by Graphene-PEDOT:PSS Fillers

Conventional devices lack the adaptability and responsiveness inherent in the design of nature. Therefore, they cannot autonomously maintain themselves in natural environments. This limitation is primarily because of using rigid and fragile material components for their construction, which hinders their ability to adapt and evolve in changing environments. Moreover, they often cannot self-repair after injuries or significant damage. Even devices with self-healing, soft, and responsive properties often fail to seamlessly integrate all these attributes into a single, scalable, and cohesive platform. In this study, a significant breakthrough is introduced by utilizing graphene-poly(3,4-ethylenedioxythiophene): polystyrene sulfonate (graphene-PEDOT:PSS) fillers to transform a typically weak, insulating, and jelly-like material into a soft electronic material with properties akin to those of living organisms, such as skin tissue. The developed electronic materials exhibit a range of other capabilities attributed to the hierarchical organization originating from filler enhancement, which includes methods such as heat regulation, 3D printability, and multiplex sensing. The introduction of this new class of materials can facilitate the self-maintenance of life-like soft robots and bioelectronics that can be seamlessly integrated within dynamic environments, such as the human body, while demonstrating the ability to sense, respond, and adapt to challenging environments.

An Integrated Janus Bioelectronic Bandage for Unidirectional Pumping and Monitoring of Wound Exudate

Single-functional wound dressings provide limited therapeutic benefits for chronic wound healing. Effective care for chronic wounds requires a multifunction that integrates exudate management, therapeutic treatment, and continuous monitoring. Here, we introduce an integrated Janus bioelectronic wound care bandage designed to achieve self-pumping exudate management via an electrospinning Janus dressing with opposite wettability, antibacterial properties through silver nanoparticles (AgNPs), and the monitoring of multiplex biomarkers in wounds via electrochemical sensors positioned on the drainage side. The limits of detection (LOD) of sensors are 0.15 mM for glucose, 6.85 μM for UA, and 60.76 mV/decade for pH (4-8), respectively. We demonstrated in mice full-thickness wound models that this bandage effectively promoted wound healing, achieving a wound closure rate of 90.35% on day 14, and monitored the dynamic changes of three biomarkers within wounds in situ over a period of 3 days.

Multifunctional Hydrogel Electronics for Synergistic Therapy and Visual Monitoring in Wound Healing

To overcome the limitations of precise monitoring and inefficient wound exudate management in wound healing, an advanced multifunctional hydrogel electronics (MHE) platform based on MXene@MOF/Fe3O4@C photonic crystal hydrogel is developed. This platform combines optical/electrical sensing, synergistic therapy, and real-time visual monitoring into a single, efficient system, offering a comprehensive solution for wound healing. Under photothermal stimulation, the hydrogel releases metal ions that generate hydroxyl radicals, effectively eliminating antibiotic-resistant bacteria. Beyond its antibacterial efficacy, this system offers unprecedented real-time monitoring through temperature-responsive visualization, while structural color changes upon wound exudate absorption provide a clear indication for dressing replacement. By integrating these functionalities, MHE platform allows for precise control of the therapeutic process, significantly improving wound healing and treatment monitoring. The platform's optical/electrical sensing capabilities further broaden its potential applications across other biomedical fields. This breakthrough technology provides clinicians with a powerful tool to optimize therapeutic outcomes, marking a major advancement in wound care and biomedical applications.

Electrochemical pH Sensor Incorporated Wearables for State-of-the-Art Wound Care

Nonhealing chronic wounds pose severe physiological and psychological distress to patients, making them a significant concern for global public health. Effective wound management strategies assisted by smart wearable pH monitoring have the potential to substantially alleviate both social and economic burdens. The pH of the wound exudate serves as a valuable indicator for predicting infections and assessing the healing status of wounds. This review comprehensively summarizes fundamental aspects related to wound pH, with a particular emphasis on the relationships between pH and healing status, infections, and other biochemical parameters that are crucial for wound health. It systematically discusses advancements in electrochemical pH sensors specifically designed for wearable devices, emphasizing their core performance in the care of chronic wounds. Additionally, the review outlines the challenges faced by this field and suggests future directions for research and development.

Using Three-Dimensional Bioprinting to Generate Realistic Models of Wound Healing

Significance: The skin serves as the primary defense against external stimuli, making it vulnerable to damage. Injuries can cause a dysregulated environment, resulting in chronic inflammation and inhibition of cell proliferation and migration, which delays recovery. Innovative approaches, such as three-dimensional (3D) bioprinting, can foster a controlled healing environment by promoting synergy between the skin microbiome and cells. Recent Advances: Traditional approaches to wound healing have focused on fostering an environment conducive to the interplay between cells, extracellular proteins, and growth factors. 3D bioprinting, a manufacturing technology with applications in tissue engineering, deposits biomaterial-based bioink containing living cells to fabricate custom-designed tissue scaffolds in a layer-by-layer fashion. This process controls the architecture and composition of a construct, producing multilayered and complex structures such as skin. Critical Issues: The selection of biomaterials for scaffolds has been a challenge when 3D skin tissue engineering. While prioritizing mechanical properties, current biomaterials often lack the ability to interact with environmental stimuli such as pH, temperature, or oxygen levels. Employing smart biomaterials that integrate bioactive molecules and adapt to external conditions could overcome these limitations. This innovation would enable scaffolds to create a sustainable wound-healing environment, fostering microbiome balance, reducing inflammation, and facilitating cellular recovery and tissue restoration, addressing critical gaps in existing wound care solutions. Future Directions: Novel bioink formulations for skin injury recovery are focused on improving long-term cell viability, proliferation, vascularization, and immune integration. Efficient recovery of the skin microbiome using bioactive molecules has the potential to create microenriched environments that support the recovery of the skin microbiome and restore immune regulation. This promising direction for future research aims to improve patient outcomes in wound care.

An antimicrobial and adhesive conductive chitosan quaternary ammonium salt hydrogel dressing for combined electrical stimulation and photothermal treatment to promote wound healing

The aim of this study is to investigate the effect of the adhesive, conductive hydrogel on wound healing when used as a therapeutic dressing. Herein, a dressing of PVA/QCS/TP@Fe3+ (PQTF) was designed and prepared integrating polyvinyl alcohol (PVA), chitosan quaternary ammonium salt (QCS), tea polyphenol (TP), and ferric ions (Fe3+) by a simple one-pot and freeze-thaw method. In view of the comprehensive properties of PQTF600 hydrogel, including adhesion, electrical conductivity, and swelling performance, PQTF600 was selected for subsequent in vitro and in vivo healing promotion studies. PQTF600 had good adhesion and conductive ability, which was suitable for human motion monitoring and wound treatment. Notably, the PQTF600 showed and controllable human safety temperature thresholds (~44.8 °C) under near-infrared light (NIR). Meanwhile, PQTF600 achieved nearly 100 % antibacterial activity against Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), and Pseudomonas putida (P. putida), methicillin-resistant Staphylococcus aureus (MRSA). In addition, the PQTF600 hydrogel dressing was demonstrated to achieve 99.59 ± 4.11 % would healing rate in a mouse trauma model under the dual stimulation of NIR (808 nm) and electricity (1.5 V direct current). The versatile PQTF600 hydrogel is a promising dressing for enhancing wound closure integrating with electrical stimulation (ES) and photothermal therapy.

The Printed Path to Healing: Advancing Wound Dressings through Additive Manufacturing

Wound care challenges healthcare systems worldwide as traditional dressings often fall short in addressing the diverse and complex nature of wound healing. Given conventional treatments limitations, innovative alternatives are urgent. Additive manufacturing (AM) has emerged as a distinct and transformative approach for developing advanced wound dressings, offering unprecedented functionality and customization. Besides exploring the AM processes state-of-the-art, this review comprehensively examines the application of AM to produce cellular-compatible and bioactive, therapeutic agent delivery, patient-centric, and responsive dressings. This review distinguishes itself from the published literature by covering a variety of wound types and by summarizing important data, including used materials, process/technology, printing parameters, and findings from in vitro, ex vivo, and in vivo studies. The prospects of AM in enhancing wound healing outcomes are also analyzed in a translational and cost-effective manner.

Negative Pressure Smart Patch to Sense and Heal the Wound

Negative pressure wound therapy (NPWT) offers significant advantages in terms of rate and time for healing through generating sub-vacuum to draw out inflammatory exudate and promote wound closure. However, continuous drainage probably leads to healing delay due to the lack of information about the real status of the wound bed and the potential risk of infection. To address this concern, printed Negative Pressure Smart Patch (NPSP) is reported by integrating smart real-time sensing acidity (infection) and glucose, and anti-infection into NPWT systems. In addition, NPSP delivers vancomycin through chitosan porous microspheres under negative pressure to modulate wound healing. Compared with NPWT, NPSP projects a promising approach to removing bacteria, reducing local inflammation, and accelerating healing in a short period of time.

Chronic wound management: a liquid diode-based smart bandage with ultrasensitive pH sensing ability

Chronic wounds, which require prolonged healing periods, pose significant impacts on individuals with diabetes, vascular diseases, and high blood pressure. Simultaneous drainage and monitoring of wound exudate are vital for advanced wound management. However, recently reported smart dressings either lack integration of wound cleaning and monitoring functions or fail to achieve dynamic in situ monitoring of wound status, which hinders their ability to meet the demands of wound care. In this study, a smart bandage is introduced, which integrates a biocompatible liquid diode membrane with an ultrasensitive 3D polyaniline mesh (M-PANI)-based pH biosensor. The smart bandage allows for unidirectional drainage of wound exudate while dynamically sensing the wound pH environment. Specifically, the proposed smart bandage effectively cleans excessive wound exudate while providing real-time information on the wound status during the drainage process. The M-PANI-based pH biosensor demonstrates a high sensitivity of 61.5 mV/pH and a wide pH detection range from 4.0 to 10.0, encompassing the pH range of normal and infected wounds. Moreover, the sensing module exhibits excellent stability after 48 hours of dynamic testing and 28 days of storage, with only a 4.8% decline in the detected signal, and high repeatability with a device-to-device relative standard deviation (RSD) of 3.1%. To evaluate the practicality of this smart bandage, simulated skin and rats have been employed, and the results indicate the immense potential of this smart bandage for clinical applications. In conclusion, the present smart bandage demonstrates considerable promise for wound exudate cleaning and monitoring in advanced wound care and offers a promising method for home-based wound management.

Customized surface adhesive and wettability properties of conformal electronic devices

Conformal and body-adaptive electronics have revolutionized the way we interact with technology, ushering in a new era of wearable devices that can seamlessly integrate with our daily lives. However, the inherent mismatch between artificially synthesized materials and biological tissues (caused by irregular skin fold, skin hair, sweat, and skin grease) needs to be addressed, which can be realized using body-adaptive electronics by rational design of their surface adhesive and wettability properties. Over the past few decades, various approaches have been developed to enhance the conformability and adaptability of bioelectronics by (i) increasing flexibility and reducing device thickness, (ii) improving the adhesion and wettability between bioelectronics and biological interfaces, and (iii) refining the integration process with biological systems. Successful development of a conformal and body-adaptive electronic device requires comprehensive consideration of all three aspects. This review starts with the design strategies of conformal electronics with different surface adhesive and wettability properties. A series of conformal and body-adaptive electronics used in the human body under both dry and wet conditions are systematically discussed. Finally, the current challenges and critical perspectives are summarized, focusing on promising directions such as telemedicine, mobile health, point-of-care diagnostics, and human-machine interface applications.

Inflammatory and vaso-occlusive ulcers: Part II - Management

In the second part of this CME, we present an approach for the management of inflammatory and vaso-occlusive ulcers and highlight the need for further research in this field. The 3 overarching principles for management are etiology-specific treatment, ulcer care, and consideration of patient comorbidities and risk factors for poor healing. Both etiology-specific treatment and management of patient comorbidities and risk factors often require collaboration with providers from other specialties. Ulcer care is governed by tissue debridement, infection control, management of moisture imbalance, and epithelial edge advancement. As wound healing is a dynamic process, management should be adapted to changes in the status of the ulcer.

Hypoxia Preconditioned Serum Hydrogel (HPS-H) Accelerates Dermal Regeneration in a Porcine Wound Model

Harnessing the body's intrinsic resources for wound healing is becoming a rapidly advancing field in regenerative medicine research. This study investigates the effects of the topical application of a novel porcine Hypoxia Preconditioned Serum Hydrogel (HPS-H) on wound healing using a minipig model over a 21-day period. Porcine HPS exhibited up to 2.8× elevated levels of key angiogenic growth factors (VEGF-A, PDGF-BB, and bFGF) and demonstrated a superior angiogenic effect in a tube formation assay with human umbilical endothelial cells (HUVECs) in comparison to porcine normal serum (NS). Incorporating HPS into a hydrogel carrier matrix (HPS-H) facilitated the sustained release of growth factors for up to 5 days. In the in vivo experiment, wounds treated with HPS-H were compared to those treated with normal serum hydrogel (NS-H), hydrogel only (H), and no treatment (NT). At day 10 post-wounding, the HPS-H group was observed to promote up to 1.7× faster wound closure as a result of accelerated epithelialization and wound contraction. Hyperspectral imaging revealed up to 12.9% higher superficial tissue oxygenation and deep perfusion in HPS-H-treated wounds at day 10. The immunohistochemical staining of wound biopsies detected increased formation of blood vessels (CD31), lymphatic vessels (LYVE-1), and myofibroblasts (alpha-SMA) in the HPS-H group. These findings suggest that the topical application of HPS-H can significantly accelerate dermal wound healing in an autologous porcine model.

Integration of Functional Polymers and Biosensors to Enhance Wound Healing

Biosensors have led to breakthroughs in the treatment of chronic wounds. Since the discovery of the oxygen electrode by Clarke, biosensors have evolved into the design of smart bandages that dispense drugs to treat wounds in response to physiological factors, such as pH or glucose concentration, which indicate pathogenic tendencies. Aptamer-based biosensors have helped identify and characterize pathogenic bacteria in wounds that often form antibiotic-resistant biofilms. Several functional polymers have served as indispensable parts of the fabrication of these biosensors. Beginning with natural polymers such as alginate, chitosan, and silk-based fibroin, which are biodegradable and absorptive, advances have been made in formulating biocompatible synthetic polymers such as polyurethane and polyethylene glycol designed to reduce non-specific binding of proteins and cells, making biosensors less painful or cumbersome for patient use. Recently, polycaprolactone has been developed, which offers ductility and a large surface-area-to-volume ratio. There is still room for advances in the fabrication and use of biosensors for wound healing and in this review, the trend in developing biosensors from biomarker detection to smart dressings to the incorporation of machine learning in designing customized wound patches while making application easier is highlighted and can be used for a long time.

Spatially controllable fluid hydrogel with in-situ electrospinning PCL/chitosan fiber for treating irregular wounds

Skin injuries sustained during exercise are often irregular in shape and frequently accompanied by infections. Bacteria residing in the crevices of these wounds can lead to persistent infections. Routine wound monitoring, which requires removing the wound dressing to assess recovery, is inconvenient and increases the risk of infection. To address this, we prepared a polyvinyl alcohol/polyhydroxylated fullerenes ((PVA/PHF) hydrogel with good fluidity and photothermal antibacterial properties, which can penetrate into the crevices of irregular wounds. After the hydrogel was applied to the wound, the hydrogel was locally defined by the polycaprolactone/Chitosan (PCL/CS) membrane of in-situ electrospinning, which effectively killed bacteria, and the healing efficiency was increased by 240 % in the wound healing experiment. The PVA/PHF hydrogel exhibits excellent electrical conductivity, making it suitable for real-time monitoring of human body motion as a strain sensor. This capability provides doctors with an accurate basis for wound assessment. At the same time, the hydrogel can achieve self-healing within 1.5 s and withstand up to 2200 % tensile strain, which can be used for large-scale motion monitoring of the human body. This flowable hydrogel, capable of penetrating wound crevices, offers a dual function of both treatment and monitoring.

A Scoping Review of 'Smart' Dressings for Diagnosing Surgical Site Infection: A Focus on Arthroplasty

Early diagnosis and treatment of surgical wound infection can be challenging. This is especially relevant in the management of periprosthetic joint infection: early detection is key to success and reducing morbidity, mortality and resource use. 'Smart' dressings have been developed to detect parameters suggestive of infection. This scoping review investigates the current status of the field, limited to devices tested in animal models and/or humans, with a focus on their application to arthroplasty. The literature was searched using MEDLINE/PubMed and Embase databases from 2000 to 2023. Original articles assessing external sensing methods for the detection of wound infection in animal models or human participants were included. Sixteen articles were eligible. The results were broadly divided by sensing method: colorimetric, electrochemical and fluorescence/photothermal responses. Six of the devices detected more than one parameter (multimodal), while the rest were unimodal. The most common parameters examined were temperature and pH. Most 'smart' dressings focused on diagnosing infection in chronic wounds, and none were tested in humans with wound infections. There is limited late-stage research into using dressing sensors to diagnose wound infection in post-surgical patients. Future research should explore this to enable inpatient and remote outpatient monitoring of post-operative wounds to detect wound infection.

Smart photonic crystal hydrogels for visual glucose monitoring in diabetic wound healing

Diabetes is a global chronic disease that seriously endangers human health and characterized by abnormally high blood glucose levels in the body. Diabetic wounds are common complications which associate with impaired healing process. Biomarkers monitoring of diabetic wounds is of great importance in the diabetes management. However, actual monitoring of biomarkers still largely relies on the complex process and additional sophisticated analytical instruments. In this work, we prepared hydrogels composed of different modules, which were designed to monitor different physiological indicators in diabetic wounds, including glucose levels, pH, and temperature. Glucose monitoring was achieved based on the combination of photonic crystal (PC) structure and glucose-responsive hydrogels. The obtained photonic crystal hydrogels (PCHs) allowed visual monitoring of glucose levels in physiological ranges by readout of intuitive structural color changes of PCHs during glucose-induced swelling and shrinkage. Interestingly, the glucose response of double network PCHs was completed in 15 min, which was twice as fast as single network PCHs, due to the higher volume fraction of glucose-responsive motifs. Moreover, pH sensing was achieved by incorporation of acid-base indicator dyes into hydrogels; and temperature monitoring was obtained by integration of thermochromic powders in hydrogels. These hydrogel modules effectively monitored the physiological levels and dynamic changes of three physiological biomarkers, both in vitro and in vivo during diabetic wound healing process. The multifunctional hydrogels with visual monitoring of biomarkers have great potential in wound-related monitoring and treatment.

Amoxicillin-laded sodium alginate/cellulose nanocrystals/polyvinyl alcohol composite nanonetwork sponges with enhanced wound healing and antibacterial performance

Wound healing is a complex process and reuires a long repair process. Poor healing effect is normally a challenge for wound healing. Designing sponge dressings with drug-assisted therapy, good breathability, and multiple functional structures effectively promotes wound healing. In this work, a flexible amoxicillin-laded (AMX) sodium alginate (SA)/cellulose nanocrystals (CNCS)/ polyvinyl alcoho (PVA) (SA/CNCS/PVA-AMX, SCP-AMX) wound dressing was designed and built with an excellent porous structure, suitable porosity, and anti-bacterial properties for promoting wound tissue reparation. The porous structure of the wound dressing was fabricated by freeze-thawing cyclic and freeze-dried molding process. This wound dressing exhibited a 3D porous structure for soft-tissue-engineering application, including high porosity (84.2 %), swelling ratio (1513 %), tensile strength (1.79 MPA), and flexibility. With the inhibition zones of Escherichia Coli (E. coli) and Staphylococcus Aureus (S, Aureus) being 1.96 and4.58 cm, respectively, this wound dressing demonstrated good antibacterial activity against E. coli and S. aureus. More importantly, wound healing Assay in vivo indicates that SCP-AMX could inhibit wound infection, promote collagen deposition, reduce inflammation, and accelerate granulation tissue and wound healing. Thus, the reported wounding dressings present excellent biocompatibility, high antibacterial activities, and excellent biosafety with great potential in wound healing applications.

Remote-Controlled Sensing and Drug Delivery via 3D-Printed Hollow Microneedles

Remote health monitoring and treatment serve as critical drivers for advancing health equity, bridging geographical and socioeconomic disparities, ensuring equitable access to quality healthcare for those in underserved or remote regions. By democratizing healthcare, this approach offers timely interventions, continuous monitoring, and personalized care independent of one's location or socioeconomic status, thereby striving for an equitable distribution of health resources and outcomes. Meanwhile, microneedle arrays (MNAs), revolutionize painless and minimally invasive access to interstitial fluid for drug delivery and diagnostics. This paper introduces an integrated theranostic MNA system employing an array of colorimetric sensors to quantitatively measure -pH, glucose, and lactate, alongside a remotely-triggered system enabling on-demand drug delivery. Integration of an ultrasonic atomizer streamlines the drug delivery, facilitating rapid, pumpless, and point-of-care drug delivery, enhancing system portability while reducing complexities. An accompanying smartphone application interfaces the sensing and drug delivery components. Demonstrated capabilities include detecting pH (3 to 8), glucose (up to 16 mm), and lactate (up to 1.6 mm), showcasing on-demand drug delivery, and assessing delivery system performance via a scratch assay. This innovative approach confronts drug delivery challenges, particularly in managing chronic diseases requiring long-term treatment, while also offering avenues for non-invasive health monitoring through microneedle-based sensors.

Self-powered biosensing sutures for real-time wound monitoring

Effective wound management has the potential to reduce both the duration and cost of wound healing. However, traditional methods often rely on direct observation or complex and expensive biological testing to monitor and evaluate the invasive damage caused by wound healing, which can be time-consuming. Biosensors offer the advantage of precise and real-time monitoring, but existing devices are not suitable for integration with sensitive wound tissue due to their external dimensions. Here, we have designed a self-powered biosensing suture (SPBS) based on biofuel cells to accurately monitor glucose concentration at the wound site and promote wound healing. The anode of the SPBS consists of carbon nanotubes-modified carbon fibers, tetrathiafulvalene (TTF), and glucose oxidase (GOx), while the cathode is composed of Ag2O and carbon nanotubes modified nanotubes modified carbon fibers. It was observed that SPBS exhibited excellent physical and chemical stability in vitro. Regardless of different bending degrees or pH values, the maximum power density of SPBS remained above 92%, which is conducive to long-term dynamic evaluation. Furthermore, the voltage generated by SPBS reflects blood glucose concentration, and measurements at wound sites are consistent with those obtained using a commercially available blood glucose meter. SPBS achieves the healing effect of traditional medical sutures after complete healing within 14 days. It offers valuable insights for intelligent devices dedicated to real-time wound monitoring.

Magneto-responsive biocomposites in wound healing: from characteristics to functions

The number of patients with non-healing wounds continuously increases, and has become a prominent societal issue that imposes a heavy burden on both patients and the entire healthcare system. Although traditional dressings play an important role in wound healing, the complexity and diversity of the healing process pose serious challenges in this field. Magneto-responsive biocomposites, with their excellent biocompatibility, remote spatiotemporal controllability, and unique convenience, demonstrate enticing advantages in the field of wound dressings. However, current research on magneto-responsive biocomposites as wound dressings lacks comprehensive and in-depth reviews, which to some extent, restricts the deeper understanding and further development of this field. Based on this, this paper reviews the latest advances in magnetic responsive wound dressings for wound healing. First, we review the process of skin wound healing and parameters for assessing repair progress. Then, we systematically discuss the preparation strategies and unique characteristics of magneto-responsive biocomposites, focusing on magneto-induced orientation, magneto-induced mechanical stimulation, and magnetocaloric effect. Subsequently, this review elaborates the multiple mechanisms of magneto-responsive biocomposites in promoting wound healing, including regulating cell behavior, enhancing electrical signal, controlling drug release, and accelerating tissue reconstruction. Finally, we further propose the development direction and future challenges of magnetic responsive biomaterials as wound dressings in clinical application.

Electronic Skin for Health Monitoring Systems: Properties, Functions, and Applications

Electronic skin (e-skin), a skin-like wearable electronic device, holds great promise in the fields of telemedicine and personalized healthcare because of its good flexibility, biocompatibility, skin conformability, and sensing performance. E-skin can monitor various health indicators of the human body in real time and over the long term, including physical indicators (exercise, respiration, blood pressure, etc.) and chemical indicators (saliva, sweat, urine, etc.). In recent years, the development of various materials, analysis, and manufacturing technologies has promoted significant development of e-skin, laying the foundation for the application of next-generation wearable medical technologies and devices. Herein, the properties required for e-skin health monitoring devices to achieve long-term and precise monitoring and summarize several detectable indicators in the health monitoring field are discussed. Subsequently, the applications of integrated e-skin health monitoring systems are reviewed. Finally, current challenges and future development directions in this field are discussed. This review is expected to generate great interest and inspiration for the development and improvement of e-skin and health monitoring systems.

Smart theranostics for wound monitoring and therapy

To overcome the challenges of poor wound diagnosis and limited clinical efficacy of current wound management, wound dressing materials with the aim of monitoring various biomarkers vital to the wound healing process such as temperature, pH, glucose concentration, and reactive oxygen species (ROS) and improving the therapeutic outcomes have been developed. These innovative theranostic dressings are smartly engineered using stimuli-responsive biomaterials to monitor and regulate local microenvironments and deliver cargos to the wound sites in a timely and effective manner. This review provides an overview of recent advances in novel theranostics for wound monitoring and therapy as well as giving insights into the future treatment of wounds via smart design of theranostic materials.

Portable Photoacoustic Analytical System Combined with Wearable Hydrogel Patch for pH Monitoring in Chronic Wounds

Timely diagnosis, monitoring, and management of chronic wounds play crucial roles in improving patients' quality of life, but clinical evaluation of chronic wounds is still ambiguous and relies heavily on the experience of clinician, resulting in increased social and financial burden and delay of optimal treatment. During the different stages of the healing process, specific and dynamic changes of pH values in the wound exudate can be used as biomarkers to reflect the wound status. Herein, a pH-responsive agent with well-behaved photoacoustic (PA) properties, nitrazine yellow (NY), was incorporated in poly(vinyl alcohol)/sucrose (PVA/Suc) hydrogel to construct a wearable pH-sensing patch (PVA/Suc/NY hydrogel) for monitoring of pH values during chronic wound healing. According to Rosencwaig-Gersho theory and the combination of 3D printing technology, the PA chamber volume and chopping frequency were systematically optimized to improve the sensitivity of the PA analytical system. The prepared PVA/Suc/NY hydrogel patch had excellent mechanical properties and flexibility and could maintain conformal contact with skin. Moreover, combined with the miniaturized PA analytical device, it had the potential to detect pH values (5.0-9.0) free from the color interference of blood and therapeutic drugs, which provides a valuable strategy for wound pH value monitoring by PA quantitation. This strategy of combining the wearable hydrogel patch with portable PA analysis offers broad new prospects for the treatment and management of chronic wounds due to its features of simple operation, time savings, and anti-interference.

Nanozymes for the Therapeutic Treatment of Diabetic Foot Ulcers

Diabetic foot ulcers (DFU) are chronic, refractory wounds caused by diabetic neuropathy, vascular disease, and bacterial infection, and have become one of the most serious and persistent complications of diabetes mellitus because of their high incidence and difficulty in healing. Its malignancy results from a complex microenvironment that includes a series of unfriendly physiological states secondary to hyperglycemia, such as recurrent infections, excessive oxidative stress, persistent inflammation, and ischemia and hypoxia. However, current common clinical treatments, such as antibiotic therapy, insulin therapy, surgical debridement, and conventional wound dressings all have drawbacks, and suboptimal outcomes exacerbate the financial and physical burdens of diabetic patients. Therefore, development of new, effective and affordable treatments for DFU represents a top priority to improve the quality of life of diabetic patients. In recent years, nanozymes-based diabetic wound therapy systems have been attracting extensive interest by integrating the unique advantages of nanomaterials and natural enzymes. Compared with natural enzymes, nanozymes possess more stable catalytic activity, lower production cost and greater maneuverability. Remarkably, many nanozymes possess multienzyme activities that can cascade multiple enzyme-catalyzed reactions simultaneously throughout the recovery process of DFU. Additionally, their favorable photothermal-acoustic properties can be exploited for further enhancement of the therapeutic effects. In this review we first describe the characteristic pathological microenvironment of DFU, then discuss the therapeutic mechanisms and applications of nanozymes in DFU healing, and finally, highlight the challenges and perspectives of nanozyme development for DFU treatment.

Enhancing wound healing through deep reinforcement learning for optimal therapeutics

Finding the optimal treatment strategy to accelerate wound healing is of utmost importance, but it presents a formidable challenge owing to the intrinsic nonlinear nature of the process. We propose an adaptive closed-loop control framework that incorporates deep learning, optimal control and reinforcement learning to accelerate wound healing. By adaptively learning a linear representation of nonlinear wound healing dynamics using deep learning and interactively training a deep reinforcement learning agent for tracking the optimal signal derived from this representation without the need for intricate mathematical modelling, our approach has not only successfully reduced the wound healing time by 45.56% compared to the one without any treatment, but also demonstrates the advantages of offering a safer and more economical treatment strategy. The proposed methodology showcases a significant potential for expediting wound healing by effectively integrating perception, predictive modelling and optimal adaptive control, eliminating the need for intricate mathematical models.

Biomimetic Materials for Skin Tissue Regeneration and Electronic Skin

Biomimetic materials have become a promising alternative in the field of tissue engineering and regenerative medicine to address critical challenges in wound healing and skin regeneration. Skin-mimetic materials have enormous potential to improve wound healing outcomes and enable innovative diagnostic and sensor applications. Human skin, with its complex structure and diverse functions, serves as an excellent model for designing biomaterials. Creating effective wound coverings requires mimicking the unique extracellular matrix composition, mechanical properties, and biochemical cues. Additionally, integrating electronic functionality into these materials presents exciting possibilities for real-time monitoring, diagnostics, and personalized healthcare. This review examines biomimetic skin materials and their role in regenerative wound healing, as well as their integration with electronic skin technologies. It discusses recent advances, challenges, and future directions in this rapidly evolving field.

Metal-Phenolic Nanocapsules with Photothermal Antibacterial and Ros Scavenging Ability for Diabetic Wound Healing

The presence of bacteria in diabetic wounds not only leads to the formation of biofilms but also triggers oxidative stress and inflammatory responses, which hinder the wound-healing process. Therefore, it is imperative to formulate a comprehensive strategy that can proficiently eliminate bacteria and enhance the wound microenvironment. Herein, this work develops multifunctional metal-phenolic nanozymes (TA-Fe/Cu nanocapsules), wherein the one-pot coordination of tannic acid (TA)and Fe3+/Cu2+ using a self-sacrificial template afforded hollow nanoparticles (NPs) with exceptional photothermal and reactive oxygen species scavenging capabilities. After photothermal disruption of the biofilms, TA-Fe/Cu NPs autonomously capture bacteria through hydrogen bonding interactions with peptidoglycans (the bacterial cell wall component), ultimately bolstering the bactericidal efficacy. Furthermore, these NPs exhibit peroxidase-like enzymatic activity, efficiently eliminating surplus hydrogen peroxide in the vicinity of the wound and mitigating inflammatory responses. As the wound transitions into the remodeling phase, the presence of Cu2+ stimulates vascular migration and regeneration, expediting the wound-healing process. This study innovatively devises a minimalist approach to synthesize multifunctional metal-phenolic nanozymes integrating potent photothermal antibacterial activity, bacterial capture, anti-inflammatory, and angiogenesis properties, showcasing their great potential for diabetic wound treatment.

Recent advances of hydrogels as smart dressings for diabetic wounds

Chronic diabetic wounds have been an urgent clinical problem, and wound dressings play an important role in their management. Due to the design of traditional dressings, it is difficult to achieve adaptive adhesion and on-demand removal of complex diabetic wounds, real-time monitoring of wound status, and dynamic adjustment of drug release behavior according to the wound microenvironment. Smart hydrogels, as smart dressings, can respond to environmental stimuli and achieve more precise local treatment. Here, we review the latest progress of smart hydrogels in wound bandaging, dynamic monitoring, and drug delivery for treatment of diabetic wounds. It is worth noting that we have summarized the most important properties of smart hydrogels for diabetic wound healing. In addition, we discuss the unresolved challenges and future prospects in this field. We hope that this review will contribute to furthering progress on smart hydrogels as improved dressing for diabetic wound healing and practical clinical application.

Functional electrospun nanofibers: fabrication, properties, and applications in wound-healing process

Electrostatic spinning as a technique for producing nanoscale fibers has recently attracted increasing attention due to its simplicity, versatility, and loadability. Nanofibers prepared by electrostatic spinning have been widely studied, especially in biomedical applications, because of their high specific surface area, high porosity, easy size control, and easy surface functionalization. Wound healing is a highly complex and dynamic process that is a crucial step in the body's healing process to recover from tissue injury or other forms of damage. Single-component nanofibers are more or less limited in terms of structural properties and do not fully satisfy various needs of the materials. This review aims to provide an in-depth analysis of the literature on the use of electrostatically spun nanofibers to promote wound healing, to overview the infinite possibilities for researchers to tap into their biomedical applications through functional composite modification of nanofibers for advanced and multifunctional materials, and to propose directions and perspectives for future research.

Next-generation of smart dressings: Integrating multiplexed sensors and theranostic functions

Non-healing wounds represent a significant burden for healthcare systems and society, giving rise to severe economic and human issues. Currently, the use of dressings and visual assessment represent the primary and standard care for wounds. Conventional dressings, like cotton gauze, provide only passive physical protection. Besides, they end up paradoxically hampering the wound-healing process by producing tissue damage and pain when removed during routine check-ups. In response to these limitations, researchers, engineers, and technologists are developing innovative dressings that incorporate advanced diagnostic and therapeutic functionalities, coined as "smart dressings". Now, the maturation of smart dressing is bringing them closer to real-life applications, leading to an exciting new generation of these devices. The next generation of smart dressings is capable of monitoring in real-time multiple biomarkers while including pro-healing capabilities in a single platform. Such multiplexed and theranostic smart dressings are expected to offer a timely biomarker-directed diagnosis of non-healing wounds while enabling rapid, automated, and personalized treatments of infection and chronicity. Herein, we provide an insightful overview of these advantageous devices, delving into the diverse spectrum of possible engineering strategies. This encompasses the use of electrochemical and optical platforms with diverse multiplexing architectures, such as multi-zone sensing arrays and multi-layered devices. Open or closed-loop theranostic mechanisms using various stimuli-responsive materials that could be internally or externally controlled are also included. Finally, a critical discussion on the main challenges and future directions of smart dressings is also offered.

The emerging progress on wound dressings and their application in clinic wound management

BACKGROUND

In addition to its barrier function, the skin plays a crucial role in maintaining the stability of the body's internal environment and normal physiological functions. When the skin is damaged, it is important to select proper dressings as temporary barriers to cover the wound, which can exert significant effects on defence against microbial infection, maintaining normal tissue/cell functions, and coordinating the process of wound repair and regeneration. It now forms an important approach in clinic practice to facilitate wound repair.

SEARCH STRATEGIES

We conducted a comprehensive literature search using online databases including PubMed, Web of Science, MEDLINE, ScienceDirect, Wiley Online Library, CNKI, and Wanfang Data. In addition, information was obtained from local and foreign books on biomaterials science and traumatology.

RESULTS

This review focuses on the efficacy and principles of functional dressings for anti-bacteria, anti-infection, anti-inflammation, anti-oxidation, hemostasis, and wound healing facilitation; and analyses the research progress of dressings carrying living cells such as fibroblasts, keratinocytes, skin appendage cells, and stem cells from different origins. We also summarize the recent advances in intelligent wound dressings with respect to real-time monitoring, automatic drug delivery, and precise adjustment according to the actual wound microenvironment. In addition, this review explores and compares the characteristics, advantages and disadvantages, mechanisms of actions, and application scopes of dressings made from different materials.

CONCLUSION

The real-time and dynamic acquisition and analysis of wound conditions are crucial for wound management and prognostic evaluation. Therefore, the development of modern dressings that integrate multiple functions, have high similarity to the skin, and are highly intelligent will be the focus of future research, which could drive efficient wound management and personalized medicine, and ultimately facilitate the translation of health monitoring into clinical practice.

Multifunctional Asymmetric Bacterial Cellulose Membrane with Enhanced Anti-Bacterial and Anti-Inflammatory Activities for Promoting Infected Wound Healing

An asymmetric wound dressing acts as a skin-like structure serves as a protective barrier between a wound and its surroundings. It allows for the absorption of tissue fluids and the release of active substances at the wound site, thus speeding up the healing process. However, the production of such wound dressings requires the acquisition of specialized tools, expensive polymers, and solvents that contain harmful byproducts. In this study, an asymmetric bacterial cellulose (ABC) wound dressing using starch as a porogen has been developed. By incorporating silver-metal organic frameworks (Ag-MOF) and curcumin into the ABC membrane, the wound dressing gains antioxidant, reactive oxygen species (ROS) scavenging, and anti-bacterial activities. Compared to BC-based wound dressings, this dressing promotes efficient dissolution and controlled release of curcumin and silver ions. In a full-thickness skin defect model, wound dressing not only inhibits the growth of bacteria on infected wounds but also regulates the release of curcumin to reduce inflammation and promote the production of epithelium, blood vessels, and collagen. Consequently, this dressing provides superior wound treatment compared to BC-based dressing.

Development and Prospective Applications of 3D Membranes as a Sensor for Monitoring and Inducing Tissue Regeneration

For decades, tissue regeneration has been a challenging issue in scientific modeling and human practices. Although many conventional therapies are already used to treat burns, muscle injuries, bone defects, and hair follicle injuries, there remains an urgent need for better healing effects in skin, bone, and other unique tissues. Recent advances in three-dimensional (3D) printing and real-time monitoring technologies have enabled the creation of tissue-like membranes and the provision of an appropriate microenvironment. Using tissue engineering methods incorporating 3D printing technologies and biomaterials for the extracellular matrix (ECM) containing scaffolds can be used to construct a precisely distributed artificial membrane. Moreover, advances in smart sensors have facilitated the development of tissue regeneration. Various smart sensors may monitor the recovery of the wound process in different aspects, and some may spontaneously give feedback to the wound sites by releasing biological factors. The combination of the detection of smart sensors and individualized membrane design in the healing process shows enormous potential for wound dressings. Here, we provide an overview of the advantages of 3D printing and conventional therapies in tissue engineering. We also shed light on different types of 3D printing technology, biomaterials, and sensors to describe effective methods for use in skin and other tissue regeneration, highlighting their strengths and limitations. Finally, we highlight the value of 3D bioengineered membranes in various fields, including the modeling of disease, organ-on-a-chip, and drug development.