Bringing Wound Care into the 21st Century

amit gefen wound care

With self-driving cars, 3-D printers, and virtual reality, technology is completely changing the way we go about our lives and our work. It has been particularly useful in the field of medicine, where nearly every branch has seen breakthrough after breakthrough.

The modern era is truly one of technological revolution.

The prevention and treatment of chronic wounds, however, remained largely untouched by the immense changes going on all around it.

That is, of course, until recently.

With the advent of emerging technologies like miniature ultrasound which employs smartphone or tablet platforms, SEM scanners, prophylactic dressings, and 3-D computer modeling, the prevention and treatment of pressure injuries has emerged as one of the most technologically advanced streams of medicine.

Amit Gefen, Professor of Bioengineering at Tel Aviv University and the Herbert J. Berman Chair in Vascular Bioengineering, is a central figure in the efforts to help bring the prevention and treatment of pressure injuries into the 21st century.

Dr. Gefen, who serves as chair of the Institute for Pressure Injury Prevention’s scientific advisory board, has been an early champion of the power of technology to help prevent pressure injuries and to diagnose them early enough in their development that they can be treated before they even break through the skin's surface.

His combination of technological skills, medical knowledge, and visionary leadership positions him as one of the most important figures in the field for the foreseeable future.

Reducing the Load – Preventative Measures

Dr. Gefen's research involves creating virtual computer models to find the true causes of pressure injuries (deformation-inflicted tissue damage which begins deep beneath the skin) and then finding solutions via bioengineering. For example, the skin’s exposure to pressure, friction and shear can be measured in 3-D computer models and then reduced by engineering alternatives.

"Bioengineering has been used to test car safety and experiment with other engineering challenges, but it’s new to this world," he said, referring to prevention and treatment of pressure injuries. "If you design a bridge, and the bridge needs to bear the load of 15 trucks, you test it to make sure it can do its job. A hip replacement or knee implant has been tested rigorously with computer simulations to make sure they can take the loads, weight, force and movement required for walking and physical activity over many years," Professor Gefen notes. "We’re applying the same concepts here. You build a virtual environment that simulates physical and mechanical factors and interactions between the human body and its surroundings including medical devices such as hospital beds and wheelchair seats."

Those results are then combined and weighted together with clinical trials.

"Clinical trials include the variability of the real world - different ages, localities, body weight, friction, temperature, elevation, health status and morbidities and even cultures. The two methods together – computer modeling and clinical trials - get us to the answers we need."

The Bridge Between Prevention and Diagnostics

New products – smarter products – are being developed to bridge the gap between pressure injury prevention and early diagnostics.

One emerging technology that has already gained widespread adoption is the prophylactic dressing, which absorbs much of the bodyweight-force-related mechanical loads over vulnerable areas, thereby reducing the likelihood of skin and deeper tissue damage.

These dressings are consumable products that are made of layered structures of special materials; they are applied directly to vulnerable areas (such as heels or the sacrum) for patients who are confined to bed. Given adequate design and selection of materials, composition and overall structure of the dressing, these products alleviate and absorb the mechanical loads so that there is substantially less tissue distortion. Dressings for prophylactic have been proven in rigorous bioengineering studies performed by Dr. Gefen and his research group as well as in large-scale randomized clinical trials.

"This is an emerging, powerful technology that is being very quickly adapted. It takes time for the scientific evidence related to these products to be accumulated and published, and then, for the knowledge to be disseminated and absorbed in the global medical community.”

"It’s a true medical technology revolution that we’re experiencing," Professor Gefen states. "We are learning how to mitigate effectively."

Along similar lines, designers have begun to apply "smart" technologies - capable of adjusting according to the needs of the patient - to other types of preventive equipment, such as support surfaces and body positioners which are often needed in operation rooms and for medical examinations such as MRI and CT scans. Some of these aids, he noted, are made of "shape memory materials" similar to memory foam pillows but more sophisticated. These devices adopt the shape and anatomy of the individual body rather than force patients to adopt a ‘one-size-fits-all’ model that has long been dominant in the medical world.

Early Diagnostics - From Ultrasounds to SEM Sensors

In real-life conditions, not all pressure injuries can be prevented, but they can be diagnosed at a much earlier stage than ever before. Early diagnosis, which refers to catching a deep pressure injury developing before it has emerged to the skin surface, provides an opportunity for the body to fight the forming wound without aggressive medical interventions that will later be required for repair (and damage would still be irreversible).

Sub-epidermal moisture (SEM) buildup is localized, micro-scale edema that indicates early cell death events that could eventually deteriorate to a full-scale pressure injury. The rise in SEM is a telltale sign of the injury – resulting from activation of an early phase of the inflammatory response - but it happens under the skin's surface and is invisible to the naked eye. The development of SEM scanners promises to reveal this inflammatory response, enabling nurses or staff to immediately remove the injurious load off the skin in the vulnerable area, letting the body fight off the nascent pressure injury.

Ultrasound technology is also spreading widely and can even be accessed through apps to smart phones and tablets, however, ultrasounds still require experts to read the results, and is not quantitative in nature. "The new miniature ultrasound technology is keeping up but there is still a major gap," Dr. Gefen said.

The Next Breakthrough in Technology

It is hard to predict where the next technological breakthrough will come from, because they are happening virtually all the time, in all areas of our lives.

We can now “see” better below the skin to diagnose a pressure injury that hasn't reached the skin surface yet. We can cover vulnerable areas with prophylactic dressings and further protect those areas using smart positioners. We can limit the amount of mechanical loads on vulnerable areas of the body, hence reducing tissue distortion and minimizing the risk of pressure injuries.

All of these breakthroughs have changed the lives of countless patients. Every pressure injury that is prevented saves an immense amount of patient and family suffering, staff and facility time, hospital funds and overall, society resources.

Investing in medical technology is a way of investing in a brighter future. And with the breakthroughs in pressure injury prevention and early diagnosis that have already taken place, it's an investment that's paying off spectacularly at all levels, from the individual to the society.