September 6, 2023 – You cut yourself. You placed on a bandage. Your wound will heal in about every week.
Most people take this routine without any consideration. But for the greater than 8.2 million Americans who've chronic wounds, it's not that easy.
Traumatic injuries, post-operative complications, advanced age and chronic illnesses equivalent to diabetes and vascular disease can disrupt the fragile healing process and lead to wounds that last for months or years.
Untreated approx 30% result in amputation. And recent studies show that the chance of dying from a chronic wound complication inside five years is comparable to that of most individuals Cancer diseases.
But until recently, medical technology had not kept pace with what experts say is a growing threat to the general public Health.
“Wound care, despite all the billions of products sold, still exists at a medieval level,” said Geoffrey Gurtner, MD, chair of the department of surgery and professor of biomedical engineering on the University of Arizona College of Medicine. “We still apply poultices and ointments… and when it comes to diagnosing infections, it really is an art. I think we can do better.
Old-school association meets AI
Gurtner is among dozens of clinicians and researchers reinventing the humble bandage – combining cutting-edge materials science with artificial intelligence (AI) and patient data to develop “smart bandages” that do much more than just shield a wound.
One day soon, these wafer-thin bandages equipped with miniaturized electronics could monitor the healing process in real time and alert the patient—or a doctor—if something goes wrong. By pressing a smartphone button, this bandage could deliver medication to fight an infection or an electrical pulse to stimulate healing.
Some “closed-loop” designs don't require a prompt, but as an alternative monitor the wound and mechanically provide it with what it needs.
Others in development could stop the bleeding of a battlefield wound or boost the healing of an explosion wound, thereby stopping long-term disability.
The same technologies could – if the value is correct – speed up healing and reduce scarring for smaller cuts and abrasions, said Gurtner.
And unlike many cutting-edge medical innovations, these next-generation bandages might be produced relatively inexpensively and profit among the most vulnerable populations, including older adults, low-income people and other people in developing countries.
They could also save the health care system money, because the U.S. spends greater than $28 billion annually on chronic disease treatment Wounds.
“This is a condition that many patients find shameful and embarrassing, so there hasn't been much advocacy,” said Gurtner, outgoing chief executive of the Wound Healing Society. “It is a relatively ignored problem that affects an underserved population and incurs enormous costs. It’s a perfect storm.”
How wounds heal or not
Wound healing is probably the most complex human processes Body.
The first blood platelets rush to the injury and trigger blood clotting. Then immune cells release compounds called inflammatory cytokines, which help fight off pathogens and keep infections at bay. Other compounds, including nitric oxide, stimulate the expansion of recent blood vessels and collagen to rebuild skin and connective tissue. As the inflammation slows and stops, the flesh continues to form.
However, some diseases can delay the method, often within the inflammatory stage.
In individuals with diabetes, high glucose levels and poor circulation are likely to sabotage the method. And individuals with nerve damage from spinal cord injuries, diabetes or other conditions may not give you the chance to feel when a wound worsens or is injured again.
“Patients end up with open wounds that fester and become infected for months,” said Roslyn Rivkah Isseroff, MD, professor of dermatology on the University of California Davis and director of the Wound Healing Clinic on the VA Northern California Health Care System. “Patients are upset about the smell. These open ulcers put the patient at risk of systemic infection such as sepsis.” It can have an effect on mental health and affect the patient’s ability to take care of wounds.
“We see them once a week and send them home and tell them to change every day and they say, 'I can barely move.' “I can’t do this,” Isseroff said.
To check for infection, the dressings must be removed and the wound cultured. This can be painful and results take time.
A lot can happen to a wound in a week.
“Sometimes they arrive back and it's a disaster and so they must be taken to the emergency room and even have it amputated,” Gurtner said.
People whose housing conditions are unsafe or who do not have access to medical care are even more vulnerable to complications.
“If you would say, 'Something bad is occurring,' you would do rather a lot to forestall this cascade and downward spiral.”
Bandages 2.0
In 2019, the Defense Advanced Research Projects Agency (DARPA) – the research arm of the Defense Department – launched the Bioelectronics for Tissue Regeneration (BETR) program to encourage scientists to develop a “closed loop.” bandage is able to both monitor and accelerate healing.
Since then, tens of millions in funding have sparked a flood of innovation.
“It's kind of a race to the finish,” said Marco Rolandi, PhD, an associate professor of electrical and computer engineering at the University of California Santa Cruz and lead researcher on a team of engineers, physicians and computer scientists from UC Santa Cruz, UC Davis and Tufts. “I was amazed and impressed by all the work that came out of it.”
His team's goal is to cut healing time in half by (a) using real-time monitoring of wound healing – using indicators such as temperature, pH, oxygen, humidity, glucose, electrical activity and certain proteins, and (b) appropriate stimulation .
“Every wound is different, so there is no one-size-fits-all solution,” said Isseroff, the team’s clinical lead. “The idea is that it will be able to sense different parameters specific to the wound, use AI to figure out what stage it is in and give the right stimulus to get it out of that stuck stage to throw out.”
The team has developed a proof-of-concept prototype: a bandage embedded with a tiny camera that captures images and transmits them to a computer algorithm to assess the wound's progress. Miniaturized battery-powered actuators or motors deliver medication automatically.
Phase I studies in rodents went well, Rolandi said. The team is now testing the bandage on pigs.
Other promising developments are underway around the world.
In a scientific paper published in May, researchers at the University of Glasgow, Scotland, described a new “low-cost, environmentally friendly” bandage with embedded light-emitting diodes (LEDs) that use ultraviolet light to kill bacteria – no antibiotics required. The fabric is stitched with a slim, flexible coil that powers the lights without a battery using wireless energy transfer. In laboratory studies, gram-negative bacteria (some of the worst bacteria) have been eradicated within 6 hours.
Also in the journal in May Bioactive materialsA team from Penn State developed a drug-injecting bandage with microneedles that can stop bleeding immediately after an injury. In laboratory and animal studies, it reduced clotting time from 11.5 minutes to 1.3 minutes and reduced bleeding 90%.
“In bleeding injuries, it is often the blood loss – rather than the injury itself – that causes death,” said study author Amir Sheikhi, PhD, assistant professor of chemical and biomedical engineering at Penn State. “Those 10 minutes could mean the difference between life and death.”
Another smart bandage developed at Northwestern University – electrodes and all – dissolves harmlessly in the body when no longer needed, eliminating what can be painful distance.
Guillermo Ameer, DSc, a study author who reports on the technology in Scientific advanceshopes that it can be manufactured inexpensively and used in developing countries.
“We want to create something that you can use in your home, even in a very remote village,” said Ameer, a professor of biomedical engineering at Northwestern University.
Schedule for clinical use
According to scientists, intelligent bandages are still in their early stages. Most studies have been conducted on rodents and more work is needed to develop human-scale bandages, reduce costs, solve long-term data storage, and ensure that the material adheres well without irritating the skin.
However, Gurtner is confident that some iterations could be used in clinical practice within a few years.
In May, he and colleagues at Stanford University published an article in Natural biotechnology Description of your smart bandage. It contains a microcontroller unit, a radio antenna, biosensors, and an electrical stimulator, all mounted on a rubbery, skin-like polymer (or hydrogel) about the thickness of a single layer of latex paint.
The dressing detects changes in temperature and electrical conductivity because the wound heals. And there may be electrical stimulation to hurry healing.
Animals treated with the bandage healed 25% faster and had 50% fewer scars.
Electric currents are already getting used in clinical practice for wound healing, said Gurtner. Because the inducement is already approved and the associated fee of manufacturing the bandage might be low (as little as $10 to $50), he believes the approval process could undergo relatively quickly.
“Is this the ultimate embodiment of all the bells and whistles possible in an intelligent association? No, not yet,” he said. “But we believe it will help people. And for now, that’s good enough.”