New Developments in Smart Bandage Technologies for Wound Diagnostics

Microgels sense wounds' temperature, pH and glucose

Wound healing concerns almost all bed-side related diseases. With our increasing comprehension of healing nature, the physical and chemical natures behind the wound microenvironment have been decoupled. Wound care demands timely screening and prompt diagnosis of wound complications such as infection and inflammation. Biosensor by the way of exhaustive collection, delivery, and analysis of data, becomes indispensable to arrive at an ideal healing upshot and controlling complications by capturing in-situ wound status. Electrochemical based sensors carry some potential unstable performance subjected to the electrical circuitry and power access and contamination. The colorimetric sensors are free from those concerns. We report that microsensors designed from O/W/O of capillary fluids can continuously monitor wound temperature, pH and glucose concentration. We combined three different types of microgels to encapsulate liquid crystals of cholesterol, nontoxic fuel litmus and two glucose-sensitizing enzymes. A smartphone applet was then developed to convert wound healing images to RGB of digitalizing data. The microgel dressing effectively demonstrates the local temperature change, pH and glucose levels of the wound in high resolution where a microgel is a 'pixel'. They are highly responsive, reversible and accurate. Monitoring multiple physicochemical and physiological indicators provides tremendous potential with insight into healing processing.

Early wound infection monitoring via headspace O2 micro-respirometry

A luminescence based, inexpensive, 3D printed O2 indicator is incorporated into a commercial, clear, occlusive wound dressing, which allows the %O2 in the headspace above a simulated wound to be monitored. Two wound models are used to evaluate this micro-respirometry-based system for monitoring wound infection namely, a simple 'agar plug' model and a wounded porcine skin model. Inoculation of either wound model with E. coli, E. cloacae, or A. baumannii, produces the typical 'S'-shaped, τ vs incubation time, t, profiles, associated with micro-respirometry, due to the decrease in %O2 in the headspace above the wound. A threshold value for the lifetime, τTT, of 21.1 μs, is identified at which the bacterial load is equal to the critical colonization threshold, CCT, ca. 106 colony forming units, CFU/mL, above which infection is highly likely. The agar plug wound model/O2 indicator combination is used to identify when the CCT is reached for a wide range of inoculant concentrations, spanning the range 108-101 CFU/mL, for all three microbial species. The O2 indicator is also successfully evaluated using a porcine skin wound model inoculated with E. coli. The results of this work are compared to other reported, usually invasive, smart wound monitoring systems. The possible use of this new, non-invasive smart-wound dressing technology, both at the point of care and at home, are discussed briefly.

A Living Microecological Hydrogel with Microbiota Remodeling and Immune Reinstatement for Diabetic Wound Healing

Dysregulated skin microbiota and compromised immune responses are the major etiological factors for non-healing diabetic wounds. Current antibacterial strategies fail to orchestrate immune responses and indiscriminately eradicate bacteria at the wound site, exacerbating the imbalance of microbiota. Drawing inspiration from the beneficial impacts that probiotics possess on microbiota, a living microecological hydrogel containing Lactobacillus plantarum and fructooligosaccharide (LP/FOS@Gel) is formulated to remodel dysregulated skin microbiota and reinstate compromised immune responses, cultivating a conducive environment for optimal wound healing. LP/FOS@Gel acts as an "evocator," skillfully integrating the skin microecology, promoting the proliferation of Lactobacillus, Ralstonia, Muribaculum, Bacillus, and Allobaculum, while eradicating colonized pathogenic bacteria. Concurrently, LP/FOS@Gel continuously generates lactic acid to elicit a reparative macrophage response and impede the activation of the nuclear factor kappa-B pathway, effectively alleviating inflammation. As an intelligent microecological system, LP/FOS@Gel reinstates the skin's sovereignty during the healing process and effectively orchestrates the harmonious dialogue between the host immune system and microorganisms, thereby fostering the healing of diabetic infectious wounds. These remarkable attributes render LP/FOS@Gel highly advantageous for pragmatic clinical applications.

Nanofiber-reinforced self-healing polysaccharide-based hydrogel dressings for pH discoloration monitoring and treatment of infected wounds

The escalating global health concern arises from chronic wounds induced by bacterial infections, posing a significant threat to individuals. Consequently, an imperative exist for the development of hydrogel dressings to facilitate prompt wound monitoring and efficacious wound management. To this end, pH-sensitive bromothymol blue (BTB) and pH-responsive drug tetracycline hydrochloride (TH) were introduced into the polysaccharide-based hydrogel to realize the integration of wound monitoring and controlled treatment. Polysaccharide-based hydrogels were formed via a Schiff base reaction by cross-linking carboxymethyl chitosan (CMCS) on an oxidized sodium alginate (OSA) skeleton. BTB was used as a pH indicator to monitor wound infection through visual color changes visually. TH could be dynamically released through the pH response of the Schiff base bond to provide effective treatment and long-term antibacterial activity for chronically infected wounds. In addition, introducing polylactic acid nanofibers (PLA) enhanced the mechanical properties of hydrogels. The multifunctional hydrogel has excellent mechanical, self-healing, injectable, antibacterial properties and biocompatibility. Furthermore, the multifaceted hydrogel dressing under consideration exhibits noteworthy capabilities in fostering the healing process of chronically infected wounds. Consequently, the research contributes novel perspectives towards the advancement of intelligent and expeditious bacterial infection monitoring and dynamic treatment platforms.

Ultralow Power, Cleft Size-Adjustable and pH-Sensitive Hyaluronic Acid (HA) Biodevices for Acid-Sensing Ion Channels Emulation

The burgeoning implantable biodevices have unlocked new frontiers in healthcare, promising personalized monitoring strategies tailored to specific needs. Herein, hyaluronic acid (HA) is harnessed to create fully biocompatible, acidity-sensitivity and cleft-adjustable neuromorphic devices. These HA-biodevices exhibit remarkable sensitivity to pH variations, effectively mimicking biological acid-sensing ion channels (ASICs) through protonation reactions between electronegative atoms and hydrogen ions, even at ultralow driving voltage (5 mV). They can monitor joint cartilage acidity by tracking changes in proton concentration and successfully diagnose the onset of arthritis. Furthermore, by adjusting the synaptic device's cleft distance, which determines responsiveness, power efficiency and plasticity, HA-based neuromorphic devices can be tailored to meet the unique demands of various implantation sites, providing both high-sensitivity and low-heat dissipation, thus broadening their application scopes. Moreover, the HA-biodevices maintain stable performance across various bending degrees, up to a curvature radius of 7.5 mm, with flexibility and deformation resilience enabling installation on joints of varying curvatures. The combination of all-biocompatibility, high sensitivity, low heat dissipation, ultralow low power (2 pW), and extraordinary deformation tolerance paves the way for the development of versatile, multipurpose medical monitoring devices with immense potential in the field of healthcare.

Multifunctional Janus Membrane for Diabetic Wound Healing and Intelligent Monitoring

The complex microenvironment of diabetic wounds often hinders the healing process, ultimately leading to the formation of diabetic foot ulcers and even death. Dual monitoring and treatment of wounds can significantly reduce the incidence of such cases. Herein, a multifunctional Janus membrane (3D chitosan sponge-ZE/polycaprolactone nanofibers-ZP) was developed by incorporating the zinc metal-organic framework, europium metal-organic framework, and phenol red into nanofibers for diabetic wound monitoring and treatment. The directional water transport capacity of the resulting Janus membrane allows for unidirectional and irreversible drainage of wound exudate, and the multifunctional Janus membrane creates up to a 99% antibacterial environment, both of which can treat wounds. Moreover, the pH (5-8) and H2O2 (0.00-0.80 μM) levels of the wound can be monitored using the color-changing property of phenol red and the fluorescence characteristic of Eu-MOF on the obtained membrane, respectively. The healing stages of the wound can also be monitored by analyzing the RGB values of the targeted membrane images. This design can more accurately reflect the wound state and treat the wound to reduce bacterial infection and accelerate wound healing, which has been demonstrated in in vivo experiments. The results provide an important basis for early intervention in diabetic patients.

A multifunctional chitosan based porous membrane for pH-responsive antibacterial activity and promotion of infected wound healing

Unsatisfactory mechanical and antibacterial properties restricted the solo use of chitosan (CS) as a wound dressing. In this work, a novel CS/hydroxyapatite/ZIF-8 (CS/HAp/ZIF-8, CHZ-10) porous membrane was facilely constructed by in situ loading of ZIF-8 on CS/HAp. The advantages of the three compositions were rationally integrated, and the multifunctionality and practicality of this CS-based dressing were improved. HAp not only improved the mechanical strength and stability of CS, but also promoted cell proliferation and accelerated hemostasis with its released Ca2+. Meanwhile, ZIF-8 enhanced the antibacterial activity of CS by releasing antibacterial Zn2+ in a pH-responsive and sustainable manner, avoiding the bio-accumulation toxicity of heavy metals. Compared with CS/HAp and conventionally used gauze, CHZ-10 exhibited superior coagulation and hemolytic ability, as well as outstanding antibacterial activity against E. coli and S. aureus. Besides, both in vivo observation and histological evaluation demonstrated that CHZ-10 could not only effectively inhibit bacterial infection and reduce inflammation of the wound, but also promote its re-epithelialization, granulation, tissue formation and collagen fibre growth, leading to effectively enhanced wound-healing. This work provides a new method for the easy construction of multifunctional antibacterial dressings based on CS, showing promise for application in clinical wound care.

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.

Comparative analysis of electrochemical and optical sensors for detection of chronic wounds biomarkers: A review

Chronic wounds (CW) present a significant healthcare challenge due to their prolonged healing time and associated complications. To effectively treat these wounds and prevent further deterioration, monitoring their healing progress is crucial. Traditional wound assessment methods relying on visual inspection and subjective evaluation are prone to inter-observer variability. Biomarkers play a critical role in objectively evaluating wound status and predicting healing outcomes, providing quantitative measures of wound healing progress, inflammation, infection, and tissue regeneration. Recent attention has been devoted to identifying and validating CW biomarkers. Various studies have investigated potential biomarkers, including growth factors, cytokines, proteases, and extracellular matrix components, shedding light on the complex molecular and cellular processes within CW. This knowledge enables a more targeted and personalized approach to wound management. Accurate and sensitive techniques are necessary for detecting CW biomarkers. Thus, this review compares and discusses the use of electrochemical and optical sensors for biomarker determination. The advantages and disadvantages of these sensors are highlighted. Differences in detection capabilities and characteristics such as non-invasiveness, portability, high sensitivity, specificity, simplicity, cost-effectiveness, compatibility with point-of-care applications, and real-time monitoring of wound biomarkers will be pointed out and compared. In summary, this work provides an overview of CW, explores the emerging field of CW biomarkers, and discusses methods for detecting these biomarkers, with a specific focus on optical and electrochemical sensors. The potential of further research and development in this field for advancing wound care and improving patient outcomes will also be noted.

An enzyme-responsive hydrogel of ferrocene-grafted carboxymethyl chitosan as a soft electrochemical sensor for MMP-9 detection

Matrix metalloproteinase 9 (MMP-9) plays an important role in wound healing. However, overexpression of MMP-9 leads to the degradation of the newly formed extracellular matrix, which delays wound healing, ultimately leading to chronic wounds. Therefore, timely monitoring of the MMP-9 activity using simple, cost-effective methods is important to prevent the formation of chronic wounds. In this work, ferrocene-modified MMP-9 cleavage peptide (Fc-MG) modified carboxymethyl chitosan hydrogels were prepared as electrochemical biosensors. In the presence of MMP-9, the peptide chain is sheared, and the electrochemically active ferrocene segment is released. Therefore, analyzing the electrochemical activity of hydrogels using differential pulse voltammetry (DPV) can be used to determine MMP-9 activity. The results showed that the DPV peaks were correlated with the MMP-9 concentration in phosphate-buffered saline (PBS, pH 7.4) and Dulbecco's modified Eagle's medium (DMEM). Specifically, the corresponding coefficient of determination (R2) were 0.918 and 0.993. The limit of detections were 73.08 ng/mL and 131.71 ng/mL, respectively. Compared with the enzyme-linked immunosorbent assay, the hydrogel biosensor determined the concentration of MMP-9 in solution with simpler steps. This study demonstrates a novel strategy based on Fc-MG-modified hydrogels to monitor MMP-9 activity in cell secretion samples and shows the potential application in chronic wounds.

Smart Bactericidal Capsules Based on Cationic Luminescent Nanoclusters for Controllable Treatment of Drug-Resistant Bacterial Infection

Effective treatment of drug-resistant bacteria infected wound has been a longstanding challenge for healthcare systems. In particular, the development of novel strategies for controllable delivery and smart release of antimicrobial agents is greatly demanded. Herein, the design of biodegradable microcapsules carrying bactericidal gold nanoclusters (AuNCs) as an attractive platform for the effective treatment of drug-resistant bacteria infective wounds is reported. AuNC capsules are fabricated via the well-controlled layer-by-layer strategy, which possess intrinsic near-infrared fluorescence and good biocompatibility. Importantly, these AuNC capsules exhibit strong, specific antibacterial activity toward both S. aureus and methicillin-resistant S. aureus (MRSA). Further mechanistic studies by fluorescence confocal imaging and inductively coupled plasma mass spectrometry reveal that these AuNC capsules will be degraded in the S. aureus environment rather than E. coli, which then controllably release the loaded cationic AuNCs to exert antibacterial effect. Consequently, these AuNC capsules show remarkable therapeutic effect for the MRSA infected wound on a mouse model, and intrinsic fluorescence property of AuNC capsules enables in situ visualization of wound dressings. This study suggests the great potential of microcapsule-based platform as smart carriers of bactericidal agents for the effective treatment of drug-resistant bacterial infection as well as other therapeutic purposes.

Biomedical applications of stimuli-responsive "smart" interpenetrating polymer network hydrogels

In recent years, owing to the ongoing advancements in polymer materials, hydrogels have found increasing applications in the biomedical domain, notably in the realm of stimuli-responsive "smart" hydrogels. Nonetheless, conventional single-network stimuli-responsive "smart" hydrogels frequently exhibit deficiencies, including low mechanical strength, limited biocompatibility, and extended response times. In response, researchers have addressed these challenges by introducing a second network to create stimuli-responsive "smart" Interpenetrating Polymer Network (IPN) hydrogels. The mechanical strength of the material can be significantly improved due to the topological entanglement and physical interactions within the interpenetrating structure. Simultaneously, combining different network structures enhances the biocompatibility and stimulus responsiveness of the gel, endowing it with unique properties such as cell adhesion, conductivity, hemostasis/antioxidation, and color-changing capabilities. This article primarily aims to elucidate the stimulus-inducing factors in stimuli-responsive "smart" IPN hydrogels, the impact of the gels on cell behaviors and their biomedical application range. Additionally, we also offer an in-depth exposition of their categorization, mechanisms, performance characteristics, and related aspects. This review furnishes a comprehensive assessment and outlook for the advancement of stimuli-responsive "smart" IPN hydrogels within the biomedical arena. We believe that, as the biomedical field increasingly demands novel materials featuring improved mechanical properties, robust biocompatibility, and heightened stimulus responsiveness, stimuli-responsive "smart" IPN hydrogels will hold substantial promise for wide-ranging applications in this domain.

Phenolic Ligand-Metal Charge Transfer Induced Copper Nanozyme with Reactive Oxygen Species-Scavenging Ability for Chronic Wound Healing

Chronic wounds frequently arise as a complication in diabetic patients, and their management remains a significant clinical hurdle due to their nonhealing nature featured by heightened oxidative stress and impaired healing cells at the wound site. Herein, we present a 2D copper antioxidant nanozyme induced by phenolic ligand-metal charge transfer (LMCT) to eliminate reactive oxygen species (ROS) and facilitate the healing of chronic diabetic wounds. We found that polyphenol ligands coordinated on the Cu3(PO4)2 nanosheets led to a strong charge transfer at the interface and regulated the valence states of Cu. The obtained Cu nanozyme exhibited efficient scavenging ability toward different oxidative species and protected human cells from oxidative damage. The nanozyme enhanced the healing of diabetic wounds by promoting re-epithelialization, collagen deposition, angiogenesis, and immunoregulation. This work demonstrates the LMCT-induced ROS scavenging ability on a nanointerface, providing an alternative strategy of constructing metal-based nanozymes for the treatment of diabetic wounds as well as other diseases.

Photothermal and Photocatalytic Glycol Chitosan and Polydopamine-Grafted Oxygen Vacancy Bismuth Oxyiodide (BiO1-x I) Nanoparticles for the Diagnosis and Targeted Therapy of Diabetic Wounds

Treatment of diabetic wounds is a significant clinical challenge due to the massive infections caused by bacteria. In this study, multifunctional glycol chitosan and polydopamine-coated BiO1-x I (GPBO) nanoparticles (NPs) with near-infrared (NIR) photothermal and photocatalytic abilities are prepared. When infection occurs, the local microenvironment becomes acidic, and the pH-switchable GPBO can target the bacteria of the wound site. The NIR-assisted GPBO treatment exhibits anti-bacterial effects with fast response, high efficiency, and long duration to Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. GPBO achieves excellent photothermal imaging and CT imaging of the mouse subcutaneous abscess model. With the assistance of NIR irradiation, the GPBO promotes the healing of the diabetic wound model with the effects of anti-bacteria, anti-inflammation, the M2 polarization promotion of macrophages, and angiogenesis. This is the first-time report of nano-sized BiO1-x I. The synthesis and selected application for the imaging and targeted therapy of diabetic wounds are presented. This study offers an example of the NP-assisted precise diagnosis and therapy of bacterial infection diseases.

Enhanced heterogeneous interface to construct intelligent conductive hydrogel gas sensor for individualized treatment of infected wounds

In this study, we developed an enhanced heterogeneous interface intelligent conductive hydrogel NH3 sensor for individualized treatment of infected wounds. The sensor achieved monitoring, self-diagnosis, and adaptive gear adjustment functions. The PPY@PDA/PANI(3/6) sensor had a minimum NH3 detection concentration of 50 ppb and a response value of 2.94 %. It also had a theoretical detection limit of 49 ppt for infected wound gas. The sensor exhibited a fast response time of 23.2 s and a recovery time of 42.9 s. Tobramycin (TOB) was encapsulated in a self-healing QCS/OD hydrogel formed by quaternized chitosan (QCS) and oxidized dextran (OD), followed by the addition of polydopamine-coated polypyrrole nanowires (PPY@PDA) and polyaniline (PANI) to prepare electrically conductive drug-loaded PPY@PDA/PANI hydrogels. The drug-loaded PPY@PDA/PANI hydrogel was combined with a PANI/PVDF membrane to form an enhanced heterogeneous interfacial PPY@PDA/PANI/PVDF-based sensor, which could adaptively learn the individual wound ammonia response and adjust the speed of drug release from the PPY@PDA/PANI hydrogel with electrical stimulation. Drug release and animal studies demonstrated the efficacy of the PPY@PDA/PANI hydrogel in inhibiting infection and accelerating wound healing. In conclusion, the gas-sensitive conductive hydrogel sensing system is expected to enable intelligent drug delivery and provide personalized treatment for complex wound management.

Lab-on-a-Fiber Wearable Multi-Sensor for Monitoring Wound Healing

Chronic wounds are regarded as a silent epidemic, affecting 1-2% of the population and representing 2-4% of healthcare expenses. The current methods used to assess the wound healing process are based on the visual evaluation of physical parameters. This work aims to design a wearable non-invasive device capable of evaluating three parameters simultaneously: the pH and the levels of glucose and matrix metalloproteinase (MMP) present in the wound exudate. The device is composed of three independent polymer optical fibers functionalized with fluorescent-based sensing chemistries specific to the targeted analytes. Each fiber is characterized in terms of detection sensitivity and selectivity confirming their suitability for monitoring the targeted parameters in ranges relevant to the wound environment. The selectivity and robustness of the multi-sensing device are confirmed with analyses using complex solutions with different pH levels (5, 6, and 7), different concentrations of glucose (1.25, 2.5, and 5 mm), and MMP (1.25, 2.5, and 5 µg mL-1 ). Given the simple set-up, the affordability of the materials used and the possibility of detecting additional parameters relevant to wound healing, such multi-sensing fiber-based devices could pave the way for novel non-invasive wearable tools enabling the assessment of wound healing from the molecular perspective.

Multifunctional Hydrogels for the Healing of Diabetic Wounds

The healing of diabetic wounds is hindered by various factors, including bacterial infection, macrophage dysfunction, excess proinflammatory cytokines, high levels of reactive oxygen species, and sustained hypoxia. These factors collectively impede cellular behaviors and the healing process. Consequently, this review presents intelligent hydrogels equipped with multifunctional capacities, which enable them to dynamically respond to the microenvironment and accelerate wound healing in various ways, including stimuli -responsiveness, injectable self-healing, shape -memory, and conductive and real-time monitoring properties. The relationship between the multiple functions and wound healing is also discussed. Based on the microenvironment of diabetic wounds, antibacterial, anti-inflammatory, immunomodulatory, antioxidant, and pro-angiogenic strategies are combined with multifunctional hydrogels. The application of multifunctional hydrogels in the repair of diabetic wounds is systematically discussed, aiming to provide guidelines for fabricating hydrogels for diabetic wound healing and exploring the role of intelligent hydrogels in the therapeutic processes.

Self-healing hydrogels based on biological macromolecules in wound healing: A review

The complete healing of skin wounds has been a challenge in clinical treatment. Self-healing hydrogels are special hydrogels formed by distinctive physicochemically reversible bonds, and they are considered promising biomaterials in the biomedical field owing to their inherently good drug-carrying capacity as well as self-healing and repair abilities. Moreover, natural polymeric materials have received considerable attention in skin tissue engineering owing to their low cytotoxicity, low immunogenicity, and excellent biodegradation rates. In this paper, we review recent advances in the design of self-healing hydrogels based on natural polymers for skin-wound healing applications. First, we outline a variety of natural polymers that can be used to construct self-healing hydrogel systems and highlight the advantages and disadvantages of different natural polymers. We then describe the principle of self-healing hydrogels in terms of two different crosslinking mechanisms-physical and chemical-and dissect their performance characteristics based on the practical needs of skin-trauma applications. Next, we outline the biological mechanisms involved in the healing of skin wounds and describe the current application strategies for self-healing hydrogels based on these mechanisms. Finally, we analyze and summarize the challenges and prospects of natural-material-based self-healing hydrogels for skin applications.

Hydrogen sulfide releasing poly(γ-glutamic acid) biocomposite hydrogel with monitoring, antioxidant, and antibacterial properties for diabetic wound healing

Adverse factors such as high levels of glucose, oxidative stress, inflammation, and bacterial infection impede diabetic wound healing and even worsen wounds. Owing to its outstanding anti-inflammatory and antioxidant properties as well as the potential to promote cell migration and proliferation, hydrogen sulfide(H2S) gas therapy is promising for chronic diabetic wound recovery. In this work, a multifunctional poly(γ-glutamic acid)(PGA) hydrogel encapsulated with keratin-based H2S donor(KTC), ciprofloxacin(Cip), and anthocyanins(Ant) was developed. The resultant hydrogel was capable of releasing H2S, thereby promoting cell proliferation and enhancing anti-inflammation and antioxidant activity. The release of antibiotic Cip was accelerated under a diabetic wound microenvironment, thereby enhancing the antibacterial activity of the hydrogel. The encapsulated Ant could serve as a pH monitor, sensitively indicating wound pH conditions in situ and indirectly reflecting wound infection. In vivo results in diabetic wound healing suggested that PGA/Ant/KTC/Cip hydrogel reduced inflammation and promoted angiogenesis and collagen deposition, thereby accelerating wound healing.

Biomimetic dual-nanozymes with catalytic cascade reactions against diabetic wound infection

Diabetes-related chronic wounds characterized by hyperglycemia and weak alkaline milieu provide numerous advantages for bacteria growth and biofilm formation, setting a myriad of stumbling blocks for wound healing. Therefore, reshaping the spatially and temporally pathological wound microenvironment against bacterial infection is critical to rescue stalled healing progress in diabetes-related chronic wounds. Herein, we demonstrate on the room-temperature construction of a glucose oxidase (GOx)-mimicking and peroxidase (POD)-mimicking dual-nanozymes catalytic cascade system upon the partial reduction of Fe3+ to Fe2+ and the deposition of Au nanoparticles, simultaneously. The as-prepared dual-nanozymes catalytic cascade system possesses the capabilities of reshaping the pathological microenvironments of diabetic wound via glucose consumption and acidification, leading to amplified catalytic cascade activities for sterilization. On the one hand, the GOx-mimicking enzymatic activity of the catalytic cascade system can not only deplete glucose and acidize wound milieu to inhibit bacteria growth, but also utilize the weak alkaline milieu of diabetic wound to provide sufficient H2O2 and a favorable pH for subsequent OH generation. On the other hand, the POD-mimicking enzymatic activity of the catalytic cascade system can continuously produce OH for sterilization under the weak acidic milieu in the presence of abundant H2O2. Benefiting from the simply and mild preparation process and the excellent dual-nanozymes catalytic cascade activities under the deliberate evolved milieus of diabetes-related chronic wounds, our catalytic cascade system exhibits the promising healing effect and clinical translation potential against diabetic wound infection.

Progress of Hydrogel Dressings with Wound Monitoring and Treatment Functions

Hydrogels are widely used in wound dressings due to their moisturizing properties and biocompatibility. However, traditional hydrogel dressings cannot monitor wounds and provide accurate treatment. Recent advancements focus on hydrogel dressings with integrated monitoring and treatment functions, using sensors or intelligent materials to detect changes in the wound microenvironment. These dressings enable responsive treatment to promote wound healing. They can carry out responsive dynamic treatment in time to effectively promote wound healing. However, there is still a lack of comprehensive reviews of hydrogel wound dressings that incorporate both wound micro-environment monitoring and treatment functions. Therefore, this review categorizes hydrogel dressings according to wound types and examines their current status, progress, challenges, and future trends. It discusses various wound types, including infected wounds, burns, and diabetic and pressure ulcers, and explores the wound healing process. The review presents hydrogel dressings that monitor wound conditions and provide tailored treatment, such as pH-sensitive, temperature-sensitive, glucose-sensitive, pressure-sensitive, and nano-composite hydrogel dressings. Challenges include developing dressings that meet the standards of excellent biocompatibility, improving monitoring accuracy and sensitivity, and overcoming obstacles to production and commercialization. Furthermore, it provides the current status, progress, challenges, and future trends in this field, aiming to give a clear view of its past, present, and future.

Lignocellulosic Bionanomaterials for Biosensor Applications

The rapid population growth, increasing global energy demand, climate change, and excessive use of fossil fuels have adversely affected environmental management and sustainability. Furthermore, the requirements for a safer ecology and environment have necessitated the use of renewable materials, thereby solving the problem of sustainability of resources. In this perspective, lignocellulosic biomass is an attractive natural resource because of its abundance, renewability, recyclability, and low cost. The ever-increasing developments in nanotechnology have opened up new vistas in sensor fabrication such as biosensor design for electronics, communication, automobile, optical products, packaging, textile, biomedical, and tissue engineering. Due to their outstanding properties such as biodegradability, biocompatibility, non-toxicity, improved electrical and thermal conductivity, high physical and mechanical properties, high surface area and catalytic activity, lignocellulosic bionanomaterials including nanocellulose and nanolignin emerge as very promising raw materials to be used in the development of high-impact biosensors. In this article, the use of lignocellulosic bionanomaterials in biosensor applications is reviewed and major challenges and opportunities are identified.

A "Test-to-Treat" Pad for Real-Time Visual Monitoring of Bacterial Infection and On-Site Performing Smart Therapy Strategies

Skin infections are major threats to human health, causing ∼500 incidences per 10 000 person-year. In patients with diabetes mellitus, particularly, skin infections are often accompanied by a slow healing process, amputation, and even death. Timely diagnosis of skin infection strains and on-site therapy are vital in human health and safety. Herein, a double-layered "test-to-treat" pad is developed for the visual monitoring and selective treatment of drug-sensitive (DS)/drug-resistant (DR) bacterial infections. The inner layer (using carrageenan hydrogel as a scaffold) is loaded with bacteria indicators and an acid-responsive drug (Fe-carbenicillin frameworks) for infection detection and DS bacteria inactivation. The outer layer is a mechanoluminescence material (ML, CaZnOS:Mn²⁺) and visible-light responsive photocatalyst (Pt@TiO₂) incorporated elastic polydimethylsiloxane (PDMS). On the basis of the colorimetric sensing result (yellow for DS-bacterial infection and red for DR-bacterial infection), a suitable antibacterial strategy is guided and then performed. Two available bactericidal routes provided by double pad layers reflect the advantage. The controllable and effective killing of DR bacteria is realized by in situ generated reactive oxygen species (ROSs) from the combination of Pt@TiO₂ and ML under mechanical force, avoiding physical light sources and alleviating off-target side effects of ROS in biomedical therapy. As a proof-of-concept, the "test-to-treat" pad is applied as a wearable wound dressing for sensing and selectively dealing with DS/DR bacterial infections in vitro and in vivo. This multifunctional design effectively reduces antibiotic abuse and accelerates wound healing, providing an innovative and promising Band-Aid strategy in point-of-care diagnosis and therapy.

Wireless, closed-loop, smart bandage with integrated sensors and stimulators for advanced wound care and accelerated healing

'Smart' bandages based on multimodal wearable devices could enable real-time physiological monitoring and active intervention to promote healing of chronic wounds. However, there has been limited development in incorporation of both sensors and stimulators for the current smart bandage technologies. Additionally, while adhesive electrodes are essential for robust signal transduction, detachment of existing adhesive dressings can lead to secondary damage to delicate wound tissues without switchable adhesion. Here we overcome these issues by developing a flexible bioelectronic system consisting of wirelessly powered, closed-loop sensing and stimulation circuits with skin-interfacing hydrogel electrodes capable of on-demand adhesion and detachment. In mice, we demonstrate that our wound care system can continuously monitor skin impedance and temperature and deliver electrical stimulation in response to the wound environment. Across preclinical wound models, the treatment group healed ~25% more rapidly and with ~50% enhancement in dermal remodeling compared with control. Further, we observed activation of proregenerative genes in monocyte and macrophage cell populations, which may enhance tissue regeneration, neovascularization and dermal recovery.

Carbon Dot-Doped Hydrogel Sensor Array for Multiplexed Colorimetric Detection of Wound Healing

Effective wound care and treatment require a quick and comprehensive assessment of healing status. Here, we develop a carbon dot-doped hydrogel sensor array in polydimethylsiloxane (PDMS) for simultaneous colorimetric detections of five wound biomarkers and/or wound condition indicators (pH, glucose, urea, uric acid, and total protein), leading to the holistic assessment of inflammation and infection. A biogenic carbon dot synthesized using an amino acid and a polymer precursor is doped in an agarose hydrogel matrix for constructing enzymatic sensors (glucose, urea, and uric acid) and dye-based sensors (pH and total protein). The encapsulated enzymes in such a matrix exhibit improved enzyme kinetics and stability compared to those in pure hydrogels. Such a matrix also provides stable colorimetric responses for all five sensors. The sensor array exhibits high accuracy (recovery rates of 91.5-113.1%) and clinically relevant detection ranges for all five wound markers. The sensor array is established for simulated wound fluids and validated with rat wound fluids from perturbed wound models. Distinct color patterns are obtained that can clearly distinguish healing vs nonhealing wounds visually and quantitatively. This hydrogel sensor array shows great potential for on-site wound sensing due to its long-term stability, lightweight, and flexibility.

Smart microneedle patches for wound healing and management

The number of patients with non-healing wounds is generally increasing globally, placing a huge social and economic burden on every country. The complexity of the wound-healing process remains a major health challenge despite the numerous studies that have been reported on conventional wound dressings. Therefore, a therapeutic system that combines diagnostic and therapeutic modalities is essential to monitor wound-related biomarkers and facilitate wound healing in real time. Microneedles, as a multifunctional platform, are promising for transdermal diagnostics and drug delivery. Their advantages are mainly reflected in painless transdermal drug delivery, good biocompatibility, and ease of self-administration. In this work, we review recent advances in the use of microneedle patches for wound healing and monitoring. The paper first provides a brief overview of the skin structure and the wound healing process, and then discusses the current state of research and prospects for the development of wound-related biomarkers and their real-time monitoring based on microneedle sensors. It summarizes the current state of research based on the unique design of microneedle patches, including biomimetic, conductive, and environmentally responsive, to achieve wound healing. It further summarizes the prospects for the application of different microneedle-based drug delivery modalities and drug delivery substances for wound healing, due to their superior transdermal drug delivery advantages. It concludes with challenges and expectations for the use of smart microneedle patches for wound healing and management.

A Systematic Review on the Advanced Techniques of Wearable Point-of-Care Devices and Their Futuristic Applications

Personalized point-of-care testing (POCT) devices, such as wearable sensors, enable quick access to health monitoring without the use of complex instruments. Wearable sensors are gaining popularity owing to their ability to offer regular and continuous monitoring of physiological data by dynamic, non-invasive assessments of biomarkers in biofluids such as tear, sweat, interstitial fluid and saliva. Current advancements have concentrated on the development of optical and electrochemical wearable sensors as well as advances in non-invasive measurements of biomarkers such as metabolites, hormones and microbes. For enhanced wearability and ease of operation, microfluidic sampling, multiple sensing, and portable systems have been incorporated with materials that are flexible. Although wearable sensors show promise and improved dependability, they still require more knowledge about interaction between the target sample concentrations in blood and non-invasive biofluids. In this review, we have described the importance of wearable sensors for POCT, their design and types of these devices. Following which, we emphasize on the current breakthroughs in the application of wearable sensors in the realm of wearable integrated POCT devices. Lastly, we discuss the present obstacles and forthcoming potentials including the use of Internet of Things (IoT) for offering self-healthcare using wearable POCT.

Construction of chitosan-based supramolecular biofilm material for wound dressing based on natural deep eutectic solvents

Bacterial infection is still one of the main problems observed in the clinical process of wound healing, so the development of new multifunctional biocompatible materials is an urgent clinical need. A kind of supramolecular biofilm crosslinked by hydrogen bond between natural deep eutectic solvent and chitosan was studied and successfully prepared to reduce bacterial infection. Its killing rates of Staphylococcus aureus and Escherichia coli can reach 98.86 % ± 1.90 % and 99.69 % ± 0.53 %, and it can be degraded in both soil and water, showing excellent biocompatibility and biodegradability. In addition, the supramolecular biofilm material also has the UV barrier property, which can effectively avoid the secondary injury of UV to the wound. Interestingly, the cross-linking effect of hydrogen bond makes the biofilm have a more compact structure and rough surface, and gives the biofilm strong tensile properties. Overall, owing to these unique advantages, NADES-CS supramolecular biofilm has great potential for medical applications, laying the foundation for the realization of sustainable polysaccharide materials.

3D Printing of pH Indicator Auxetic Hydrogel Skin Wound Dressing

The benefits of enclosing pH sensors into wound dressings include treatment monitoring of wounded skin and early detection of developing chronic conditions, especially for diabetic patients. A 3D printed re-entrant auxetic hydrogel wound dressing, doped with pH indicator phenol red dye, was developed and characterized. The re-entrant auxetic design allows wound dressing adhesion to complex body parts, such as joints on arms and legs. Tensile tests revealed a yield strength of 140 kPa and Young's modulus of 78 MPa. In addition, the 3D-printed hydrogel has a swelling capacity of up to 14%, limited weight loss to 3% in six days, and porosity of near 1.2%. A reasonable pH response resembling human skin pH (4-10) was obtained and characterized. The integration of color-changing pH indicators allows patients to monitor the wound's healing process using a smartphone. In addition to the above, the mechanical properties and their dependence on post-processing were studied. The results show that the resin composition and the use of post-treatments significantly affect the quality and durability of the wound dressings. Finally, a poly (acrylic acid) (PAA) and water-based adhesive was developed and used to demonstrate the performance of the auxetic wound dressing when attached to moving body joints.

A self-powered multifunctional dressing for active infection prevention and accelerated wound healing

Interruption of the wound healing process due to pathogenic infection remains a major health care challenge. The existing methods for wound management require power sources that hinder their utilization outside of clinical settings. Here, a next generation of wearable self-powered wound dressing is developed, which can be activated by diverse stimuli from the patient's body and provide on-demand treatment for both normal and infected wounds. The highly tunable dressing is composed of thermocatalytic bismuth telluride nanoplates (Bi₂Te₃ NPs) functionalized onto carbon fiber fabric electrodes and triggered by the surrounding temperature difference to controllably generate hydrogen peroxide to effectively inhibit bacterial growth at the wound site. The integrated electrodes are connected to a wearable triboelectric nanogenerator (TENG) to provide electrical stimulation for accelerated wound closure by enhancing cellular proliferation, migration, and angiogenesis. The reported self-powered dressing holds great potential in facilitating personalized and user-friendly wound care with improved healing outcomes.

Recent Progress on Hydrogel-Based Piezoelectric Devices for Biomedical Applications

Flexible electronics have great potential in the application of wearable and implantable devices. Through suitable chemical alteration, hydrogels, which are three-dimensional polymeric networks, demonstrate amazing stretchability and flexibility. Hydrogel-based electronics have been widely used in wearable sensing devices because of their biomimetic structure, biocompatibility, and stimuli-responsive electrical properties. Recently, hydrogel-based piezoelectric devices have attracted intensive attention because of the combination of their unique piezoelectric performance and conductive hydrogel configuration. This mini review is to give a summary of this exciting topic with a new insight into the design and strategy of hydrogel-based piezoelectric devices. We first briefly review the representative synthesis methods and strategies of hydrogels. Subsequently, this review provides several promising biomedical applications, such as bio-signal sensing, energy harvesting, wound healing, and ultrasonic stimulation. In the end, we also provide a personal perspective on the future strategies and address the remaining challenges on hydrogel-based piezoelectric electronics.

Light-triggered theranostic hydrogels for real-time imaging and on-demand photodynamic therapy of skin abscesses

The management of wound infection remains the major challenges in real-time diagnosis, effective bacterial elimination and rapid wound healing. Herein, we developed injectable theranostic hydrogels to achieve long-term visual imaging of infected wounds and possible infection recurrence and to launch an on-demand bactericidal effect without using any antibiotics. Antimicrobial peptide ε-polylysine (ePL)-derived hydrogels were prepared through the copolymerization of methacrylated ePL (mPL) and the conjugates with tetrakis(4-carboxyphenyl) porphyrin (mPL-TCPP) and phenol red (mPL-Pr). Light illumination of mPL-TCPP produces reactive oxidative species (ROS) to initiate free radical crosslinking into PL@Pr-TCPP hydrogels without using any additional photoinitiators and concurrently exhibits antibacterial photodynamic therapy (PDT). PL@Pr-TCPP hydrogels experience quick color changes from yellow to orange and finally to red when pH values change from 5.0 to 9.0. The actual pH and related bacterial levels in the wounds could be read from G/B signal ratios of hydrogel colors captured by a smart phone. The conjugation of phenol red and TCPP into hydrogels affords a robust bacterial infection diagnosis and persistent bactericidal effect after cycled light illumination. The bacterial capture by ePL hydrogels strengthens PDT effect through alleviating the short lifetime and action distance of ROS. On a Staphylococcus aureus-infected abscess model, light illumination of the pregel solutions achieves in situ formation of hydrogel dressings. The synergistic bactericidal performance significantly relieves inflammatory status, accelerates collagen deposition, and promotes neovascularization, leading to full recovery of the infected wounds with regeneration of skin accessories. PL@Pr-TCPP hydrogels on the wound bed show color changes upon the recurrence of bacterial infection, which could also be totally eliminated after light illumination. Therefore, this study demonstrates a feasible strategy to develop theranostic hydrogel dressings for life-cycle diagnosis and on-demand treatment of wound infections. STATEMENT OF SIGNIFICANCE: Over 30% of skin and soft tissue infections become chronic even after appropriate antibacterial treatment, and recurrent infections are commonly reported after initial infection. Challenges remain in the development of theranostic wound dressings having the capability of point-of-care diagnosis, life-cycle monitoring and on-demand elimination of bacterial infection. Herein, light-triggered gelation is used to develop theranostic hydrogels for reversible naked-eye diagnosis and on-demand photodynamic therapy of wound infections. Light illumination plays a "one-stone-two-birds" role, i.e., photodynamically produced reactive oxidative species enable bactericidal effect without using any antibiotics, and the generated free radicals initiate crosslinking of hydrogels without using any additional photoinitiators. Bacterial infection-activated color changes of hydrogels could be captured with a smart phone for on-site and persistent monitoring of bacterial infection and wound healing process.

Smart bioadhesives for wound healing and closure

The high demand for rapid wound healing has spurred the development of multifunctional and smart bioadhesives with strong bioadhesion, antibacterial effect, real-time sensing, wireless communication, and on-demand treatment capabilities. Bioadhesives with bio-inspired structures and chemicals have shown unprecedented adhesion strengths, as well as tunable optical, electrical, and bio-dissolvable properties. Accelerated wound healing has been achieved via directly released antibacterial and growth factors, material or drug-induced host immune responses, and delivery of curative cells. Most recently, the integration of biosensing and treatment modules with wireless units in a closed-loop system yielded smart bioadhesives, allowing real-time sensing of the physiological conditions (e.g., pH, temperature, uric acid, glucose, and cytokine) with iterative feedback for drastically enhanced, stage-specific wound healing by triggering drug delivery and treatment to avoid infection or prolonged inflammation. Despite rapid advances in the burgeoning field, challenges still exist in the design and fabrication of integrated systems, particularly for chronic wounds, presenting significant opportunities for the future development of next-generation smart materials and systems.

Amphiphilic sodium alginate-polylysine hydrogel with high antibacterial efficiency in a wide pH range

Bacterial infection is a major pathological factor leading to persistent wounds. With the aging of population, wound infection has gradually become a global health-issue. The wound site environment is complicated, and the pH changes dynamically during healing. Therefore, there is an urgent need for new antibacterial materials that can adapt to a wide pH range. To achieve this goal, we developed a thymol-oligomeric tannic acid/amphiphilic sodium alginate-polylysine hydrogel film, which exhibited excellent antibacterial efficacy in the pH range from 4 to 9, achieving the highest achievable 99.993 % (4.2 log units) and 99.62 % (2.4 log units) against Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli, respectively. The hydrogel films exhibited excellent cytocompatibility, suggesting that the materials are promising as a novel wound healing material without the concern of biosafety.

Smart 3D Printed Auxetic Hydrogel Skin Wound Dressings

Wound healing is a huge challenge worldwide causing enormous financial burden on healthcare systems. Although conventional wound dressings, such as hydrogels, bandages, and foams, facilitate wound healing, they lack the ability to monitor the wound healing process. Here, hydrogel wound dressings in the form of auxetic structures were developed by a digital light processing (DLP) printer. Paper-based colorimetric sensors were incorporated with the 3D printed auxetic hydrogel skin wound patches for monitoring the wound status through detecting pH levels and glucose concentrations. The paper-based sensors are profoundly cost-effective and were found to be capable of monitoring the wound's conditions. The developed wound dressings may assist in preventing escalation of the acute wounds into chronic stages in diabetics.

Recent advances in responsive hydrogels for diabetic wound healing

Poor wound healing after diabetes mellitus remains a challenging problem, and its pathophysiological mechanisms have not yet been fully elucidated. Persistent bleeding, disturbed regulation of inflammation, blocked cell proliferation, susceptible infection and impaired tissue remodeling are the main features of diabetic wound healing. Conventional wound dressings, including gauze, films and bandages, have a limited function. They generally act as physical barriers and absorbers of exudates, which fail to meet the requirements of the whol diabetic wound healing process. Wounds in diabetic patients typically heal slowly and are susceptible to infection due to hyperglycemia within the wound bed. Once bacterial cells develop into biofilms, diabetic wounds will exhibit robust drug resistance. Recently, the application of stimuli-responsive hydrogels, also known as "smart hydrogels", for diabetic wound healing has attracted particular attention. The basic feature of this system is its capacities to change mechanical properties, swelling ability, hydrophilicity, permeability of biologically active molecules, etc., in response to various stimuli, including temperature, potential of hydrogen (pH), protease and other biological factors. Smart hydrogels can improve therapeutic efficacy and limit total toxicity according to the characteristics of diabetic wounds. In this review, we summarized the mechanism and application of stimuli-responsive hydrogels for diabetic wound healing. It is hoped that this work will provide some inspiration and suggestions for research in this field.

Bio-macromolecular design roadmap towards tough bioadhesives

Emerging sutureless wound-closure techniques have led to paradigm shifts in wound management. State-of-the-art biomaterials offer biocompatible and biodegradable platforms enabling high cohesion (toughness) and adhesion for rapid bleeding control as well as robust attachment of implantable devices. Tough bioadhesion stems from the synergistic contributions of cohesive and adhesive interactions. This Review provides a biomacromolecular design roadmap for the development of tough adhesive surgical sealants. We discuss a library of materials and methods to introduce toughness and adhesion to biomaterials. Intrinsically tough and elastic polymers are leveraged primarily by introducing strong but dynamic inter- and intramolecular interactions either through polymer chain design or using crosslink regulating additives. In addition, many efforts have been made to promote underwater adhesion via covalent/noncovalent bonds, or through micro/macro-interlock mechanisms at the tissue interfaces. The materials settings and functional additives for this purpose and the related characterization methods are reviewed. Measurements and reporting needs for fair comparisons of different materials and their properties are discussed. Finally, future directions and further research opportunities for developing tough bioadhesive surgical sealants are highlighted.

A Comprehensive Review of the Recent Developments in Wearable Sweat-Sensing Devices

Sweat analysis offers non-invasive real-time on-body measurement for wearable sensors. However, there are still gaps in current developed sweat-sensing devices (SSDs) regarding the concerns of mixing fresh and old sweat and real-time measurement, which are the requirements to ensure accurate the measurement of wearable devices. This review paper discusses these limitations by aiding model designs, features, performance, and the device operation for exploring the SSDs used in different sweat collection tools, focusing on continuous and non-continuous flow sweat analysis. In addition, the paper also comprehensively presents various sweat biomarkers that have been explored by earlier works in order to broaden the use of non-invasive sweat samples in healthcare and related applications. This work also discusses the target analyte's response mechanism for different sweat compositions, categories of sweat collection devices, and recent advances in SSDs regarding optimal design, functionality, and performance.

Responsive and self-healing structural color supramolecular hydrogel patch for diabetic wound treatment

The treatment of diabetic wounds remains a great challenge for medical community. Here, we present a novel structural color supramolecular hydrogel patch for diabetic wound treatment. This hydrogel patch was created by using N-acryloyl glycinamide (NAGA) and 1-vinyl-1,2,4-triazole (VTZ) mixed supramolecular hydrogel as the inverse opal scaffold, and temperature responsive poly(N-isopropylacrylamide) (PNIPAM) hydrogel loaded with vascular endothelial cell growth factor (VEGF) as a filler. Supramolecular hydrogel renders hydrogel patch with superior mechanical properties, in which NAGA and VTZ also provide self-healing and antibacterial properties, respectively. Besides, as the existence of PNIPAM, the hydrogel patch was endowed with thermal-responsiveness property, which could release actives in response to temperature stimulus. Given these excellent performances, we have demonstrated that the supramolecular hydrogel patch could significantly enhance the wound healing process in diabetes rats by downregulating the expression of inflammatory factors, promoting collagen deposition and angiogenesis. Attractively, due to responsive optical property of inverse opal scaffold, the hydrogel patch could display color-sensing behavior that was suitable for the wound monitoring and management as well as guidance of clinical treatment. These distinctive features indicate that the presented hydrogel patches have huge potential values in biomedical fields.

A cellulose nanofibril-reinforced hydrogel with robust mechanical, self-healing, pH-responsive and antibacterial characteristics for wound dressing applications

Background

Bacterial infection in wounds has become a major threat to human life and health. With the growth use of synthetic antibiotics and the elevated evolution of drug resistant bacteria in human body cells requires the development of novel wound curing strategies. Herein, a novel pH-responsive hydrogel (RPC/PB) was fabricated using poly(vinyl alcohol)-borax (PB) and natural antibiotic resveratrol grafted cellulose nanofibrils (RPC) for bacterial-infected wound management.

Results

In this hydrogel matrix, RPC conjugate was interpenetrated in the PB network to form a semi-interpenetrating network that exhibited robust mechanical properties (fracture strength of 149.6 kPa), high self-healing efficiency (> 90%), and excellent adhesion performance (tissue shear stress of 54.2 kPa). Interestingly, the induced RPC/PB hydrogel showed pH-responsive drug release behavior, the cumulative release amount of resveratrol in pH 5.4 was 2.33 times than that of pH 7.4, which was adapted well to the acidic wound microenvironment. Additionally, this RPC/PB hydrogel exhibited excellent biocompatibility and antioxidant effect. Moreover, in vitro and in vivo results revealed that such RPC/PB hydrogel had excellent antibacterial, skin tissue regeneration and wound closure capabilities.

Conclusion

Therefore, the generated RPC/PB hydrogel could be an excellent wound dressing for bacteria-infected wound healing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12951-022-01523-5.

Developing Wound Moisture Sensors: Opportunities and Challenges for Laser-Induced Graphene-Based Materials

Recent advances in polymer composites have led to new, multifunctional wound dressings that can greatly improve healing processes, but assessing the moisture status of the underlying wound site still requires frequent visual inspection. Moisture is a key mediator in tissue regeneration and it has long been recognised that there is an opportunity for smart systems to provide quantitative information such that dressing selection can be optimised and nursing time prioritised. Composite technologies have a rich history in the development of moisture/humidity sensors but the challenges presented within the clinical context have been considerable. This review aims to train a spotlight on existing barriers and highlight how laser-induced graphene could lead to emerging material design strategies that could allow clinically acceptable systems to emerge.

Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine

Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.

Recent Advances in Wearable Potentiometric pH Sensors

Wearable sensors reflect the real-time physiological information and health status of individuals by continuously monitoring biochemical markers in biological fluids, including sweat, tears and saliva, and are a key technology to realize portable personalized medicine. Flexible electrochemical pH sensors can play a significant role in health since the pH level affects most biochemical reactions in the human body. pH indicators can be used for the diagnosis and treatment of diseases as well as the monitoring of biological processes. The performances and applications of wearable pH sensors depend significantly on the properties of the pH-sensitive materials used. At present, existing pH-sensitive materials are mainly based on polyaniline (PANI), hydrogen ionophores (HIs) and metal oxides (MOx). In this review, we will discuss the recent progress in wearable pH sensors based on these sensitive materials. Finally, a viewpoint for state-of-the-art wearable pH sensors and a discussion of their existing challenges are presented.

In Situ Electrospinning of Aggregation-Induced Emission Nanofibrous Dressing for Wound Healing

Rapid wound dressing and effective antibacterial therapy that meet the extreme requirements of emergency situations are urgently needed for treating skin wounds. Here, an in situ deposited and personalized nanofibrous dressing is reported which can be directly electrospun on skin wounds by a handheld electrospinning device and perfectly fits different wounds of various sizes. Moreover, an aggregation-induced emission luminogen with photodynamic therapy effect is loaded in the nanofibrous dressings which endows the dressing's long-term antibacterial activity during the wound healing process. The in situ electrospun nanofibers show excellent antimicrobial activity against Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus. In vivo studies demonstrate that these antibacterial nanofibrous dressings can effectively reduce inflammation and significantly accelerate wound healing. Such an in situ produced antibacterial dressing is promising as a total solution for treating emergencies, including patient-specific clinical wounds and military injuries.

Wearable Bioelectronics for Chronic Wound Management

Chronic wounds are a major healthcare issue and can adversely affect the lives of millions of patients around the world. The current wound management strategies have limited clinical efficacy due to labor-intensive lab analysis requirements, need for clinicians' experiences, long-term and frequent interventions, limiting therapeutic efficiency and applicability. The growing field of flexible bioelectronics enables a great potential for personalized wound care owing to its advantages such as wearability, low-cost, and rapid and simple application. Herein, recent advances in the development of wearable bioelectronics for monitoring and management of chronic wounds are comprehensively reviewed. First, the design principles and the key features of bioelectronics that can adapt to the unique wound milieu features are introduced. Next, the current state of wound biosensors and on-demand therapeutic systems are summarized and highlighted. Furthermore, we discuss the design criteria of the integrated closed loop devices. Finally, the future perspectives and challenges in wearable bioelectronics for wound care are discussed.

Self-adhesive Hyaluronic Acid/Antimicrobial Peptide Composite Hydrogel with Antioxidant Capability and Photothermal Activity for Infected Wound Healing

Bacterial infection can delay wound healing, causing wounds to deteriorate and even threatening the patient's life. Recently, although many composite hydrogels as wound dressing have been developed, it is still highly desired to construct photothermal hydrogels with antimicrobial and antioxidant properties to accelerate the infected wound healing. In this work, we develop a hyaluronic acid (HA)-based composite hydrogel consisting of a dopamine-substituted antimicrobial peptide (DAP) and Iron (III) ions, which exhibits photothermal-assisted promotion and acceleration of healing process of bacteria-infected wounds. DAP, serving as both antimicrobial agent and ROS-scavenger, forms Schiff's base bonds with aldehyde hyaluronic acid (AHA) and iron-catechol coordination bonds to reinforce the composite hydrogel. The presence of Fe³⁺ can also promote covalent polymerization of dopamine, which endows the hydrogel with photothermal capacity. The in vitro and in vivo experiments prove that the composite hydrogel can effectively accelerate the infected wound healing process, including antibacterial, accelerated collagen deposition and re-epithelization. This study suggests that the multifunctional composite hydrogel possesses remarkable potential for bacteria-infected wound healing by combining inherent antimicrobial activity, antioxidant capability and photothermal effect. This article is protected by copyright. All rights reserved.

Engineered Nanotechnology: An Effective Therapeutic Platform for the Chronic Cutaneous Wound

The healing of chronic wound infections, especially cutaneous wounds, involves a complex cascade of events demanding mutual interaction between immunity and other natural host processes. Wound infections are caused by the consortia of microbial species that keep on proliferating and produce various types of virulence factors that cause the development of chronic infections. The mono- or polymicrobial nature of surface wound infections is best characterized by its ability to form biofilm that renders antimicrobial resistance to commonly administered drugs due to poor biofilm matrix permeability. With an increasing incidence of chronic wound biofilm infections, there is an urgent need for non-conventional antimicrobial approaches, such as developing nanomaterials that have intrinsic antimicrobial-antibiofilm properties modulating the biochemical or biophysical parameters in the wound microenvironment in order to cause disruption and removal of biofilms, such as designing nanomaterials as efficient drug-delivery vehicles carrying antibiotics, bioactive compounds, growth factor antioxidants or stem cells reaching the infection sites and having a distinct mechanism of action in comparison to antibiotics-functionalized nanoparticles (NPs) for better incursion through the biofilm matrix. NPs are thought to act by modulating the microbial colonization and biofilm formation in wounds due to their differential particle size, shape, surface charge and composition through alterations in bacterial cell membrane composition, as well as their conductivity, loss of respiratory activity, generation of reactive oxygen species (ROS), nitrosation of cysteines of proteins, lipid peroxidation, DNA unwinding and modulation of metabolic pathways. For the treatment of chronic wounds, extensive research is ongoing to explore a variety of nanoplatforms, including metallic and nonmetallic NPs, nanofibers and self-accumulating nanocarriers. As the use of the magnetic nanoparticle (MNP)-entrenched pre-designed hydrogel sheet (MPS) is found to enhance wound healing, the bio-nanocomposites consisting of bacterial cellulose and magnetic nanoparticles (magnetite) are now successfully used for the healing of chronic wounds. With the objective of precise targeting, some kinds of "intelligent" nanoparticles are constructed to react according to the required environment, which are later incorporated in the dressings, so that the wound can be treated with nano-impregnated dressing material in situ. For the effective healing of skin wounds, high-expressing, transiently modified stem cells, controlled by nano 3D architectures, have been developed to encourage angiogenesis and tissue regeneration. In order to overcome the challenge of time and dose constraints during drug administration, the approach of combinatorial nano therapy is adopted, whereby AI will help to exploit the full potential of nanomedicine to treat chronic wounds.

A Review of Recent Advances in Flexible Wearable Sensors for Wound Detection Based on Optical and Electrical Sensing

Chronic wounds that are difficult to heal can cause persistent physical pain and significant medical costs for millions of patients each year. However, traditional wound care methods based on passive bandages cannot accurately assess the wound and may cause secondary damage during frequent replacement. With advances in materials science and smart sensing technology, flexible wearable sensors for wound condition assessment have been developed that can accurately detect physiological markers in wounds and provide the necessary information for treatment decisions. The sensors can implement the sensing of biochemical markers and physical parameters that can reflect the infection and healing process of the wound, as well as transmit vital physiological information to the mobile device through optical or electrical signals. Most reviews focused on the applicability of flexible composites in the wound environment or drug delivery devices. This paper summarizes typical biochemical markers and physical parameters in wounds and their physiological significance, reviews recent advances in flexible wearable sensors for wound detection based on optical and electrical sensing principles in the last 5 years, and discusses the challenges faced and future development. This paper provides a comprehensive overview for researchers in the development of flexible wearable sensors for wound detection.

Non-invasive, 3D printed, colourimetric, early wound-infection indicator

A simple, non-invasive, colour-based carbon dioxide (CO₂) indicator is described. The indicator provides an indirect response to the rapid, aerobic microbial colonisation of an underlying wound when used in conjunction with an occlusive (i.e. sealed) dressing. The indicator has potential as an early warning indicator of infection in chronic wounds.

A feedback control architecture for bioelectronic devices with applications to wound healing

Bioelectronic devices can provide an interface for feedback control of biological processes in real-time based on sensor information tracking biological response. The main control challenges are guaranteeing system convergence in the presence of saturating inputs into the bioelectronic device and complexities from indirect control of biological systems. In this paper, we first derive a saturated-based robust sliding mode control design for a partially unknown nonlinear system with disturbance. Next, we develop a data informed model of a bioelectronic device for in silico simulations. Our controller is then applied to the model to demonstrate controlled pH of a target area. A modular control architecture is chosen to interface the bioelectronic device and controller with a bistable phenomenological model of wound healing to demonstrate closed-loop biological treatment. External pH is regulated by the bioelectronic device to accelerate wound healing, while avoiding chronic inflammation. Our novel control algorithm for bioelectronic devices is robust and requires minimum information about the device for broad applicability. The control architecture makes it adaptable to any biological system and can be used to enhance automation in bioengineering to improve treatments and patient outcomes.