Wound management materials and technologies from bench to bedside and beyond

Abstract

Chronic wounds represent a major global health problem, causing staggering economic and social burdens. The pursuit of effective wound healing strategies demands a multidisciplinary approach, and advances in material sciences and bioengineering have paved the way for the development of novel wound healing biomaterials and technologies. In this Review, we provide an overview of the history and challenges of wound management and highlight the current state-of-the-art in wound healing biomaterials alongside the emerging technologies poised to transform the landscape of chronic wound treatment and monitoring. Moreover, we discuss the clinical and commercial considerations associated with wound healing strategies, including the regulatory pathways and key steps in the translational process. Furthermore, we highlight existing translational gaps, and offer a nuanced understanding of the challenges that persist in translating innovative concepts into mainstream clinical practices. Continued innovations and interdisciplinary collaboration will pave the way for better wound care outcomes and potentially dramatically improved quality of life for a steadily increasing and aging population.

Figure 1.. Chronic wound healing and management process.

Schematic illustrates the process of healing process in chronic wounds. Chronic wounds exhibit a complex and protracted healing trajectory, marked by the occurrence of various healing phases in a non-linear and unpredictable fashion. Addressing the distinct challenges posed by each phase within the same wound necessitates diverse therapeutic approaches tailored to specific areas. Wound healing is facilitated by physiological activities such as angiogenesis and phagocytosis, which are driven by positive intracellular and intercellular communication involving growth factors and cytokines. Conversely, pathological conditions, including chronic inflammation, fibroblast aging, and oxidative stress, arise from disrupted signaling mechanisms. These conditions are often worsened by elements like matrix metalloproteinases (MMPs), damage-associated molecular patterns (DAMPs), and bacterial toxins, leading to wounds that do not heal. Therefore, therapeutic efforts should aim to modulate these biochemical pathways and signals to promote a shift towards healing by addressing the specific challenges that impede recovery in pathological wound healing scenarios. Advanced smart technologies and materials have been innovatively designed to tackle this complexity and provide a personalized and dynamic strategy for optimal wound management. ROS, reactive oxygen species; RNS, reactive nitrogen species.

Figure 2.. A timeline of technology development in chronic wound management.

The history of wound care devices, encompassing the United States Food and Drug Administration (USFDA)-approved innovations and those currently undergoing pre-clinical or clinical research. The history of wound care products spans from cellular level topical ointment, sophisticated therapy, to cutting-edge biosensors and portable diagnostic devices, illustrating the forward-moving trajectory of key advancements in wound management technologies. Adapted/Reproduced with permission from Refs. , , , Alliqua BioMedical, Inc., DARCO International, Klinik Inocare, Organogenesis Inc., Aesthetique Skin & Body and MolecuLight.

Figure 3.. Translational materials for wound treatment.

a, Various material types employed for chronic wound treatment, including nano/micro particles, bioscaffolds, bioelectronic materials and stimuli responsive materials. b, Physical properties including mechanical stability, adhesion, wettability, moisture control, transparency, and breathability, as well as biochemical properties such as anti-FBR, biodegradability and hemostasis. These characteristics can control a range of cellular functions and therapeutic efficiency. FBR, foreign body response. c, The materials designed to realized functionalities such as fibroblast growth stimulation, re-epithelization, vascularization, collagen deposition, scar prevention, immunomodulation, and infection prevention. d, Currently, available therapeutic approaches could be categorized as material-based therapy, extra stimuli therapy as well as material-device combinational therapy.

Figure 4.. Materials and technologies for wound analyzing and monitoring.

The schematic represents an overview of the integrated components and processes involved in advanced wound monitoring systems. This includes a holistic representation of key elements such as wound conditions, biomarkers, signal transduction, performance-enhancing materials, system integration, and strategies for wound fluid sampling and target recognition. CRISPR, clustered regularly interspaced short palindromic repeats; NFC, near field communication.