His team’s goal is to cut healing time in half by using (a) real-time monitoring of how a wound is healing – using indicators like temperature, pH level, oxygen, moisture, glucose, electrical activity, and certain proteins, and (b) appropriate stimulation.
Most people take this routine for granted. But for the more than 8.2 million Americans who have chronic wounds, it’s not so simple.
“This is a condition that many patients find shameful and embarrassing, so there hasn’t been a lot of advocacy,” said Gurtner, outgoing board president of the Wound Healing Society. “It’s a relatively ignored problem afflicting an underserved population that has a huge cost. It’s a perfect storm.”
Phase I trials in rodents went well, Rolandi said. The team is now testing the bandage on pigs.
“Is this the ultimate embodiment of all the bells and whistles that are possible in a smart bandage? No. Not yet,” he said. “But we think it will help people. And right now, that’s good enough.”
Someday soon, these paper-thin bandages embedded with miniaturized electronics could monitor the healing process in real time, alerting the patient — or a doctor— when things go wrong. With the press of a smartphone button, that bandage could deliver medicine to fight an infection or an electrical pulse to stimulate healing.
Others in development could halt a battlefield wound from hemorrhaging or kick-start healing in a blast wound, preventing longer-term disability.
“We end up with patients going months with open wounds that are festering and infected,” said Roslyn Rivkah Isseroff, MD, professor of dermatology at the University of California Davis and head of the VA Northern California Health Care System’s wound healing clinic. “The patients are upset with the smell. These open ulcers put the patient at risk for systemic infection, like sepsis.” It can impact mental health, draining the patient’s ability to care for their wound.
People who are housing insecure or lack access to health care are even more vulnerable to complications.
Wound healing is one of the most complex processes in the human body.
In 2019, the Defense Advanced Research Projects Agency (DARPA) — the research arm of the Department of Defense — launched the Bioelectronics for Tissue Regeneration (BETR) program to encourage scientists to develop a “closed-loop” bandage capable of both monitoring and hastening healing.
“If you had the ability to say ‘there is something bad happening,’ you could do a lot to prevent this cascade and downward spiral.”
“Sometimes, they come back and it’s a disaster and they have to be admitted to the ER or even get an amputation,” Gurtner said.
Animals treated with the bandage healed 25% faster, with 50% less scarring.
Some “closed-loop” designs need no prompting, instead monitoring the wound and automatically giving it what it needs.
Traumatic injuries, post-surgical complications, advanced age, and chronic illnesses like diabetes and vascular disease can all disrupt the delicate healing process, leading to wounds that last months or years.
But Gurtner is hopeful that some iteration could be used in clinical practice within a few years.
Gurtner is among dozens of clinicians and researchers reimagining the humble bandage — combining cutting-edge materials science with artificial intelligence, or AI, and patient data to develop “smart bandages” that do far more than shield a wound.
And unlike many cutting-edge medical innovations, these next-generation bandages could be made relatively cheaply and benefit some of the most vulnerable populations, including older adults, people with low incomes, and those in developing countries.
Old-School Bandage Meets AI
Checking for infection means removing bandages and culturing the wound. That can be painful, and results take time.
They could also save the health care system money, as the U.S. spends more than $28 billion annually treating chronic wounds.
But some conditions can stall the process, often in the inflammatory stage.
“We’d like to create something that you could use in your home, even in a very remote village,” said Ameer, professor of biomedical engineering at Northwestern.
“Every wound is different, so there is no one solution,” said Isseroff, the team’s clinical lead. “The idea is that it will be able to sense different parameters unique to the wound, use AI to figure out what stage it is in, and provide the right stimulus to kick it out of that stalled stage.”
Timeline for Clinical Use
In May, he and colleagues at Stanford University published a paper in Nature Biotechnology describing their smart bandage. It includes a microcontroller unit, a radio antenna, biosensors, and an electrical stimulator all affixed to a rubbery, skin-like polymer (or hydrogel) about the thickness of a single coat of latex paint.