September 6, 2023 – You cut yourself. You put a bandage on it. Your wound will heal in about every week.
For most individuals, this routine is second nature. But for the greater than 8.2 million Americans who are suffering from chronic wounds, it's not so easy.
Traumatic injuries, post-operative complications, advanced age and chronic diseases similar to diabetes and vascular disease can disrupt the fragile healing process and result in wounds that persist for months or years.
Untreated, approx. 30% result in amputation. And recent studies show that the danger of dying from a chronic wound complication inside 5 years is comparable to that of most Cancer.
But until recently, medical technology had not kept pace with the growing threat to the population, experts say. Health.
“Wound care, despite the billions of products sold, is still at a medieval level,” says Dr. Geoffrey Gurtner, chief of the department of surgery and professor of biomedical engineering on the University of Arizona School of Medicine. “We still use poultices and ointments … and when it comes to diagnosing infections, it's really an art. I think we can do better.”
Old-school bandage meets AI
Gurtner is considered one of dozens of doctors and researchers reinventing the common-or-garden bandage. They are combining cutting-edge materials science with artificial intelligence (AI) and patient data to develop “smart bandages” that may do rather more than simply protect a wound.
Soon, these ultra-thin bandages, equipped with miniaturized electronics, could monitor the healing process in real time and alert the patient – or a physician – if something goes unsuitable. At the touch of a button on a smartphone, the bandage could deliver medication to fight an infection or an electrical pulse to stimulate healing.
Some closed-loop designs don't require prompting, but somewhat monitor the wound and robotically give it what it needs.
Other drugs currently under development could stop the bleeding from a war wound or speed up the healing of an explosion wound, thus stopping long-term disability.
The same technologies – if the value is correct – could also speed up healing and reduce scarring for minor cuts and scratches, says Gurtner.
And unlike many cutting-edge medical innovations, these next-generation patches could possibly be produced relatively inexpensively and profit a number of the most vulnerable populations, including the elderly, those on low incomes and people in developing countries.
They could also save the health care system money, because the United States spends greater than $28 billion annually on treating chronic wounds.
“Many patients find this condition shameful and embarrassing, so there hasn't been a lot of engagement,” said Gurtner, outgoing board chairman of the Wound Healing Society. “It's a relatively ignored problem that afflicts an underserved population and incurs enormous costs. It's a perfect storm.”
How wounds heal – or not
Wound healing is probably the most complex processes within the human Body.
First, platelets rush to the injury and stimulate blood clotting. Then immune cells release compounds called inflammatory cytokines that 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. When the inflammation subsides 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 inclined to sabotage the method. And individuals with nerve damage from spinal cord injuries, diabetes, or other diseases may not have the opportunity to sense when a wound worsens or is re-injured.
“We have patients with open wounds that fester and become infected for months,” says Dr. Roslyn Rivkah Isseroff, 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 bothered by the smell. These open ulcers put the patient at risk of systemic infection such as sepsis.” It can impact mental health and affect the patient's ability to look after their wound.
“We see them once a week and send them home and tell them to change their dressings every day, and they say, 'I can barely move. I can't do this,'” Isseroff said.
To check for infection, dressings should be removed and a culture of the wound taken. This will be painful and results take time.
Lots can occur to a wound in every week.
“Sometimes they come back and it's a disaster and they have to be admitted to the emergency room or even have to have an amputation,” Gurtner said.
People whose housing situation is unsafe or who wouldn't have access to health care are much more vulnerable to complications.
“If you could say, 'Something bad is happening,' you could do a lot to prevent this cascade and downward spiral.”
Bandages 2.0
In 2019, the Defense Advanced Research Projects Agency (DARPA) – the research arm of the U.S. Department of Defense – launched the Bioelectronics for Tissue Regeneration (BETR) program to encourage scientists to develop a “closed loop.” bandage can each monitor and speed up healing.
Since then, funding within the tens of tens of millions has triggered a flood of innovations.
“It's kind of a race to the finish,” said Marco Rolandi, PhD, associate professor of electrical and computer engineering on the University of California Santa Cruz and principal investigator of a team of engineers, physicians and computer scientists from UC Santa Cruz, UC Davis and Tufts. “I'm amazed and impressed by all the work that's come out of this.”
His team's goal is to attain healing time through (a) real-time monitoring of wound healing—using indicators similar to 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 the system can capture different parameters specific to the wound, use artificial intelligence to figure out what stage it is in, and apply the right stimulus to get it out of that stagnant stage.”
The team has developed a proof-of-concept prototype: a bandage with a tiny camera that takes images and transmits them to a pc algorithm that assesses the wound's progress. Miniaturized battery-powered actuators or motors robotically deliver medication.
The Phase I trials on rodents went well, Rolandi said. The team is now testing the bandage on pigs.
Further promising developments are underway world wide.
In a scientific paper published in May, researchers on the University of Glasgow in Scotland described a brand 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 sewn to a skinny, flexible coil that powers the lights with no battery and with wireless energy transfer. In laboratory studies, gram-negative bacteria (a number of the worst germs) were killed inside 6 hours.
Also in May within the magazine Bioactive materialsA team from Penn State described a bandage with drug-injecting microneedles that may stop bleeding immediately after an injury. In laboratory and animal experiments, it reduced the clotting time from 11.5 minutes to 1.3 minutes and the bleeding by 90%.
“In bleeding injuries, it is often the blood loss – not the injury itself – that leads to death,” said study creator 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 intelligent bandage developed at Northwestern University dissolves harmlessly within the body – including the electrodes – when it isn't any longer needed, thus eliminating the doubtless painful distance.
Guillermo Ameer, DSc, a study creator reporting on the technology, in Scientific advanceshopes that it could possibly be manufactured cheaply and utilized in developing countries.
“We want to create something that can be used at home, even in a very remote village,” said Ameer, a professor of biomedical engineering at Northwestern University.
Schedule for clinical application
According to scientists, smart patches are still of their infancy. Most studies have been conducted on rodents, and more work is required to develop human-sized patches, reduce costs, solve long-term data storage and be sure that the fabric adheres well without irritating the skin.
However, Gurtner is confident that some iterations could possibly be utilized in clinical practice inside a number of years.
In May, he and colleagues at Stanford University published an article in Nature Biotechnology describe their intelligent association. It contains a microcontroller unit, a radio antenna, biosensors, and an electrical stimulator, all mounted on a rubbery, skin-like polymer (or hydrogel) about as thick as a single layer of latex paint.
The dressing registers temperature and electrical conductivity changes during wound healing. And it delivers electrical stimulation to hurry up healing.
The animals treated with the bandage healed 25% faster and had 50% fewer scars.
Electrical currents are already getting used in clinical practice to heal wounds, Gurtner said. Because the stimulus is already approved and the fee of producing the patch is predicted to be low (just $10 to $50), he believes the patch could move through the approval process relatively quickly.
“Is this the ultimate embodiment of all the bells and whistles possible in a smart patch? No. Not yet,” he said. “But we believe it will help people. And for now, that's good enough.”