Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine.
Maximillian A WeigeltHadar A Lev-TovMarjana Tomic-CanicW David LeeRyan WilliamsDavid StrasfeldRobert S KirsnerIra M HermanPublished in: Advances in wound care (2021)
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.
Keyphrases
- wound healing
- healthcare
- high resolution
- palliative care
- surgical site infection
- optical coherence tomography
- clinical trial
- quality improvement
- randomized controlled trial
- systematic review
- pain management
- primary care
- sars cov
- fluorescence imaging
- coronavirus disease
- affordable care act
- cardiovascular disease
- single cell
- magnetic resonance
- depressive symptoms
- risk factors
- heavy metals
- risk assessment
- cardiovascular events
- high throughput
- diabetic retinopathy
- mass spectrometry
- open label
- photodynamic therapy
- tandem mass spectrometry
- study protocol