Breakthrough Technologies in Diagnosis and Therapy of Chronic Wounds

Chronic Wounds.Wounds throughout the body are common and can be debilitating injuries with long recovery times. [1][2]2][3] Wounds that fail to proceed through the normal phases of inflammation, proliferation/repair, and remodeling remain in a dysregulated inflammatory state and are reclassified from acute to chronic wounds. 2 Chronic wounds are characterized by their inability to heal within an expected time frame and are heterogeneous in pathogenesis, size, body location, likelihood of infection, and amputation risk. 4Various disease states result in chronic wound development, including diabetes (diabetic foot ulcers), venous insufficiency (venous ulcers), and undue skin pressure (pressure ulcers). 1,[5][6]6][7] In the United States, the prevalence of chronic wounds is estimated to be 4.5 million patients, resulting in substantial economic and psychosocial costs. 2,8With risk factors for chronic wounds becoming more prevalent due to increasing population age and obesity rate, the market size of wound closure products has been increasing and was projected to exceed $25 billion USD in 2022. 8n clinical practice, chronic wounds are treated with initial and regular extensive debridement, to remove devitalized tissue, and the use of non-specific wound dressings. 2,9These commercially available wound dressings (wet gauze, hydrogels, hydrocolloids, foam dressings, films) promote wound healing by providing moisture, gas exchange, thermal insulation, drainage of exudates, a barrier against infections, and minimization of skin irritation or friction between the wound and clothing or devices such as wheelchairs. 2,10,11Some commercial bandages may also deliver debriding or antimicrobial agents. 2 More advanced commercial dressings such as acellular and cellular skin substitutes are costly and generally used in specialty settings. 1,2,12,13These skin substitutes provide a provisional extracellular matrix (ECM) substitute for cell anchorage, and function as a growth factor depot and, in the case of cellular skin substitutes, a stromal cell reservoir. 1,12urrently, the selection of the wound dressing relies on a clinical assessment of the patient's wound. 2 The wide variety of wound dressings combined with a general lack of high-quality evidence complicates wound dressing selection in clinical routine. 2,11merging Targets in Chronic Wounds.In the past two decades, our understanding of chronic wound pathophysiology has deepened.It has become increasingly accepted that the inflammatory phase is likely the most dysregulated process in chronic wounds. 1,3,14,15Chronic wounds exhibit a chronic proinflammatory environment with high levels of pro-inflammatory chemokines, cytokines, reactive oxygen species (ROS),

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