Veterans and others with limited mobility who use a wheelchair are prone to developing pressure injuries. Also referred to as pressure ulcers, pressure injuries are chronic wounds that can be painful for patients and expensive to manage – both for the individual and the health care system.
Chronic wounds that are slow to heal require repeated trips to the clinic for specialized wound care. Because many Veterans live long distances from the nearest VA medical center, treatment for them can require hospitalization over a period of months. The cost to treat pressure injuries in the U.S. is $9.1–$11.6 billion per year, according to the Agency for Healthcare Research and Quality.
It is a problem that Dr. Kath Bogie has been working on intermittently for nearly 15 years. Bogie and a team of colleagues have now created a “smart bandage” that makes use of electrical stimulation to treat chronic wounds that will not heal on their own. The high-tech bandage, called “Exciflex,” is based on technology developed by the researchers—initially named the Modular Adaptive Electrotherapy Delivery System, or MAEDS.
Exciflex was created from smart bandage technology developed by Dr. Kath Bogie and colleagues at the VA Advanced Platform Technology Center and Case Western Reserve University in Cleveland. (Illustration by Grace Gongaware)
Healing with electricity
Bogie is a biomedical engineer who specializes in chronic wound care. She works with the VA Advanced Platform Technology Center (APT), in Cleveland. She says that Veterans are one of the groups at highest risk for chronic wounds, especially those who have sustained a spinal cord injury. Service members are also more likely to experience a traumatic wound, like a blast injury, which is more complex than an acute surgical wound and has a greater risk of infection.
“As a normal wound heals, there is a lot of biological activity,” explains Bogie. “The cells start to proliferate, and the wound begins to heal and close up. A chronic wound gets stuck and doesn’t go on to heal. The general thinking is that electrical stimulation provides the energy to promote healing in a chronic wound.”
`It’s like Goldilocks’
Chronic wounds are also colonized with bacteria that may form a biofilm, which delays healing. Preliminary data suggest that using electrical stimulation can disrupt the biofilm, minimize infection, and promote the growth of new blood vessels, says Bogie.
Using electrical stimulation is not a new approach. However, the science has not been applied consistently, says Bogie. She points to multiple clinical studies that used various off-the-shelf devices to deliver electrical stimulation, like transcutaneous electrical nerve stimulation (TNS), which is typically used to treat back pain. All of these studies used a standard surface electrode that must be reapplied to the skin every time the patient needs to receive therapy. The smart bandage technology is unique in that therapy can be delivered around the clock and is not limited to clinic visits, which promotes healing.
For a wound to heal effectively, it must have the right conditions. “A wound feels better when it is kept moist and warm, but not too hot, not too dry. It’s like Goldilocks,” says Bogie. The smart bandage can stay in place for up to seven days, so the wound environment remains stable. That is one of the reasons why the smart bandage system is superior to a traditional wound dressing that must be removed every time the patient receives conventional electrical stimulation.
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