Over the past 60 years, perhaps since George Winter demonstrated the advantages of moist wound healing,1 our knowledge regarding wound prevention and treatment has increased dramatically and the field has made great progress translating new knowledge into effective practice. Watershed events from the past include the implementation of growth factors and tissue engineering systems to promote tissue repair and regrowth, the development of advanced wound dressings that promote rapid healing and prevent tissue damage through careful consideration of exudate management, the use of evidence-based risk-assessment tools to help direct care plans, and pressure-redistributing support surfaces to help prevent pressure injuries (PIs), to name just a few. But there is so much more to learn and do. In this Special Issue, "Today's Research Advances Tomorrow's Practice," we illustrate the potential for bioengineering and medical technologies to improve wound care and outcomes.
The articles in this issue represent a collection of research performed by leaders in our field. These authors are working in the most promising lines of biomedical and bioengineering research with the goal of improving wound prevention and treatment. Their efforts range from investigating genomic biomarkers of risk, to evaluating novel dressings, proposing techniques for assessing tissue damage in all skin tones, developing new dressing technologies, uncovering sources of potential infection, and improving understanding of threats to tissue integrity and health from skin-contacting medical devices.
Understanding and accurately assessing the risk of tissue damage is necessary for effective PI prevention. Although the development, validation, and implementation of risk-assessment tools have been among the most important advancements in the field, there is still room for improvement. In particular, visual cue-based scales are less effective for patients with dark skin tones. In this issue of Advances, Sonenblum and colleagues evaluated the use of technology to assess skin tone and erythema. In addition, recognizing that differences in inherent risk to people with spinal cord injuries are not well understood, Graves et al identified genetic biomarkers predisposing individuals with spinal cord injury to recurrent PIs.
Judging from the research directions currently being pursued, future breakthroughs in wound healing will likely come from bioengineered systems and materials. Here, Gardien and colleagues report on outcomes from a randomized clinical trial showing promising results for the application of an acellular dermal substitute in healing burn wounds and reconstructions. Further, Neiman et al present promising preclinical work on use of a novel hemostatic adhesive for surgical wound closure.
Focused, effective, and cost-effective clinical research must be based on thorough and rigorous bioengineering laboratory work. For example, understanding how advanced wound dressings may also protect soft tissues from PIs in a preventive/prophylactic use is in an early stage of development. Bioengineering and clinical evidence indicate that specific dressing products may be effective in PI prevention, but we do not yet understand the optimal dressing structures for PI prevention or dual prevention/treatment performance. In this issue, Fougeron et al used mathematical modeling methods to show that a two-layer dressing may reduce tissue deformations around the site of a PI and potentially prevent PI development if used prophylactically.
Other important topics covered in this Special Issue include efforts to assess newly appreciated threats to tissue integrity, such as risks posed by skin-contacting medical devices (eg, devices attached to or in contact with the face and neck) and other typical hospital equipment such as bedframes. The extent of these risks may not be fully appreciated. Call and colleagues evaluated hospital bedframes, determining that both the bedframe design and user cleaning expertise can reduce the threat from bedframes as a source of infections. Solmos et al assessed the mechanical properties of oxygen-delivery devices and nasogastric tubes commonly associated with medical device-related PIs and found that device stiffness was (not surprisingly) associated with PI risk.
The biomedical and bioengineering research reported in this Special Issue illustrates the diversity and dynamic nature of the field of wound prevention and treatment. In the medical context of the exponentially growing use of artificial intelligence/machine-learning algorithms and cloud computing/data-mining tools and the foundations that these advancements already offer to novel wound-care technologies under development, we are witnessing a rapid evolution as this field quickly becomes substantially more technology oriented and aided. The works included here are just a small sampling of all that is currently being accomplished. Are we on the verge of additional watershed discoveries in wound care and management?
Amit Gefen, PhD
Tel Aviv University, Tel Aviv, Israel
David Brienza, PhD
University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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