Smart Bandage Technology

Jordan Davidson
School of Engineering
Robert Gordon University
j.davidson7@rgu.ac.uk

September 7, 2016
Abstract

This paper reviews the current literature pertaining to smart bandage technology and outlines a concept
design for a smart adhesive bandage. The concept of the ideal dressing is defined and potential biomarkers for
wound diagnostics are elucidated. Several sensor types, namely pH, temperature and oxygen, are discussed
and advantageous substrates are reviewed. Finally, a concept for a smart bandage technology is proposed
as a result of this literature review, which includes a three-sensor bandage to detect pH, temperature and
wound oxygenation and utilises carbon-based and polymer substrates. Near-field communication and radio
frequency identification technology is also recommended.

I. Introduction Table. 1 Potential Biomarkers

Would diagnostics remain an important as-

pect to health care and non-invasive methods • Bacterial load/specific microbial
for determining wound progress are continu- species/biofilms
ally required. The development of so-called
’Smart Bandages’ is therefore beneficial within • Cytokine release in response to specific
the clinical setting. This paper reviews the microbial antigens
literature pertaining to dressing requirements,
wound diagnostic criteria and smart bandage • DNA, e.g. gene polymorphisms to
technologies, biosensors and substrates and indicate susceptibility to disease, poor
proposes a new concept design for a smart healing or infection
bandage.
• Enzymes and their substrates, e.g. matrix
metalloproteinases and extracellular
II. Wound Diagnostics matrix

Wound healing is a complex biological phe- • Growth factors and hormones, e.g.
nomenon. Due to this complexity, there exists platelet-derived growth factor (PDGF),
an abundance of potential markers for both sex steroids (androgens/oestrogens) and
diagnostic and theranostic purposes. Such a thyroid hormones
list was compiled by Harding [1] and includes
markers such as bacterial, protein and hor- • Immunohistochemical markers, e.g.
monal loads as well as nutritional, Immunohis- integrins, chemokine receptors and trans-
tochemical, inflammatory and electrochemical forming growth factor beta II receptors to
markers. The full list is reproduced in Table 1. monitor healing status
below.

1
 Smart Bandage Technology

• Inflammatory mediators, e.g. cytokines the final cosmetic appearance of the

and interleukins to monitor healing sta- healed wound where this is relevant.’
tus and guide use of anti-inflammatory
treatments
These properties are shown in Table 2
• Nitric oxide for primary requirements and Table 3 for
secondary requirements.
• Nutritional factors, e.g. zinc, glutamine,
vitamins Table. 2 Ideal Dressing Primary Require-
ments
• pH of wound fluid
• Maintains the wound and the surround-
• Reactive oxygen species
ing skin in an optimum state of hydration
(this implies the ability to absorb exudate
• Temperature
effectively under compression)

• Transepidermal water loss from peri-

• Provides protection to the periwound
wound skin
skin from potentially irritant wound
exudate and excess moisture

• If self-adhesive, forms an effective water

III. Traditional Bandages and
resistant seal to the periwound skin,
The Ideal Dressing but is easily removable without causing
trauma or skin stripping
The concept of wound dressings and ban-
dages have been around for over 30,000 years
• Forms an effective bacterial barrier
[4] but only in the 1950s was the notion of the
(effectively contain exudate or cellu-
’Ideal Dressing’ proposed by Scales et. al [5].
lar debris to prevent the transmission of
It was understood then that a compromise
microorganisms into or out of the wound)
is required in wound treatment, as no single
bandage will be suitable for every wound [4].
• Conforms well to wound and limb
Furthermore, Scales et al. acknowledged the
limitations of materials technology at the time,
• Produces minimal pain during applica-
stating that with the materials present in 1956,
tion or removal as result of adherence to
production of an ideal dressing is impossible
the wound surface
[4].

• Free of toxic or irritant extractables

Thomas [6] proposed an updated definition
of wound healing, stating:
• Does not release particles or non-
‘The ideal dressing or dressing sys- biodegradable fibers into the wound
tem provides an environment within
the wound in which the objectives • Requires minimal disturbance or replace-
of the current phase of treatment ment
may be achieved in a timely and cost
effective manner without compromis- • Maintains the wound at optimum tem-
ing either patient safety or quality perature and pH
of life, or adversely affecting the
integrity of the periwound skin or

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 Smart Bandage Technology
Table. 3 Ideal Dressing Secondary Re-
quirements
• Possesses antimicrobial activity, capable
of combating localized infection
• Has odor-absorbing/combating proper-
ties
• Has ability to remove or inactivate prote-
olytic enzymes in chronic wound fluid
• Possesses haemostatic activity
• Exhibits effective wound-cleansing (de-
briding) activity
IV. Towards Smart Bandages:
Literature Review
McLister et al. have reviewed the electrochem-
ical approaches to the development of smart
bandages [5] as well as new developments
of smart bandage technologies for wound di-
agnostic purposes [6]. In their former re-
view, a focus on electroanalytical approaches,
namely pH, baceterial metabolites, endoge-
nous wound biomarkers, volatile organic em-
misons and temperature. This approach is in
concordance with Narayan, [7], who remarked
that he dominant detection mechanism for an-
alytes in biofluid sample is the electrochem-
ical assessment and Badodkar and Wang [8],
stating that amperometry and potentiometry
methods have been commonly implemented
in the application of wearable biosensor devel-
opment for bodily fluids.
V. pH Sensors
Various approaches have been proposed for
pH sensor development in the context of smart
bandage technology. Phair et al. [9] developed
a disposable in situ pH sensor, such that the
system exploits the pH dependence of the en-
dogenous biomarker uric acid, yielding an un-
ambiguous signal. Uric acid has been demon-
strated to be elevated in wound fluid from
chronic venous leg ulcers and its relative con-
centrations correlating with wound chronicity
by Fernandez et al. [10], [11].
Kassal et al. [11] have taken this concept
further in their development of a smart ban-
dage with wireless connectivity for uric acid
biosensing, in which the electrochemical UA
biosensor displayed strong analytical perfor-
mance in vitro, with respect to sensitivity, se-
lectivity, operational stability, and robustness.
These in vitro experiments were performed by
dispensing 200 micro-L of phosphate-buffered
saline onto the sensing area of the bandage.
Moreover, Kassal et al. undertook mechanical
stress testing of the bandage, complete with
sensor in order to approximate the impact of
mechanical deformation likely to be experi-
enced when the bandage is in situ. It was
found that repeated bending stress did not
have a significant impact of the electrochem-
ical response of the smart bandage biosensor.
The biosensor itself was fabricated via screen-
printing Prussian blue modified carbon elec-
trodes onto a commercial bandage. The smart
bandage then connects to a potentiostat which
has been developed for use with mobile and
wearable biosensors specifically and has fur-
ther been integrated with wireless capability.
The measured current output from the biosen-
sor is proportional to the uric acid concentra-
tion and this data can then be sent, upon re-
quest, to a computer or smart device via radio
frequency identification or near-field commu-
nications, respectively.
VI. Temperature Sensors
It has been demonstrated that a developing di-
abetic foot ulcer may be anticipated by an in-
crease of temperature in the area at risk [12].
Moreover, similar temperature-based behavior
has been observed in bedsores as well as for
pressure ulcers [13].
Moser and Gijis [14] developed a flexi-
ble temperature sensor based on a micro-
patterned thin-film platinum resistor and in-
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 Smart Bandage Technology
corporated a biocompatible high-temperature-
resistant polyimide material, with potential
applications in the characterisation of the
thermo-ablation process of tumours. Further,
they anticipate that a small size, flat shape,
and high flexibility variation of the sensor de-
veloped will open possibilities for temperature
measurement applications.
Matzeu et al. [15] have investigated the
application of wireless sensors for skin
temperature monitoring through the use
of a conducting film with a temperature-
dependant resistivity measured by an RFID
tag. A polymeric nanocomposite based on
carbon nanotubes (CNT) was utilised as the
sensing film. Matzeu et al. published an ad-
ditional paper [16] on this subject, reporting
the fabrication of a temperature sensor based
on multi-walled carbon nanotubes/styreneb-
(ethylene-co-butylene)-b-styrene triblock
copolymer composite, in which the results left
the authors optimistic regarding feasibility
of realizing nanocomposite films with tem-
perature sensitivities comparable to that of
common thermistors.
Carbon nanotubes are of particular inter-
est within the context of biosensors, due to
their advantageous mechanical, electrical and
thermal properties [17], [18]. Indeed, the
use of carbon nanotubes for the realization
of miniaturized temperature sensors has been
suggested by [19], [20] and [21].
Experimentally, nanoscale reinforcement of
polymers has been shown to remarkably
change the properties of materials [22], and
the afore mentioned advantageous characteris-
tics shown by carbon nanotubes indicated that
their incorporation into polymeric matrices
could allow for the creation of new nanostruc-
tured materials characterised by unique prop-
erties [23], [24], [25], [26]. Moreover, carbon
nanotubes with semi-conducting or metallic
qualities have shown a resistivity as strictly a
function of temperature, thus rendering them
of interest in the development of small-scale
temperature sensors [27], [28].
4
VII. Oxygen Sensors
Mostafalu et al. [29] designed a smart bandage
with a primary functionality for continuous
monitoring of wound oxygenation through
the utilisation of off-the-shelf electronic com-
ponents and hydrogel, which was used as an
epidermal layer through which oxygen can
easily diffuse and reach an oxygen sensor. It
was shown that the flexible oxygen sensors,
electrochemical galvanic cells implemented on
parylene, had ample sensitivity and linear out-
put. The bandage material was 3D-printed
using an elastomer of advantageous mechani-
cal properties (tensile strength, flexibility, and
stretchability) called TangoPlus.
The oxygen sensor output was found to be
linear with increase in oxygen content, in ac-
cordance with accepted theory. In addition,
concerns over environmental oxygen diffusing
through the hydrogel and influencing the oxy-
gen sensors was addressed by using a cast in
a bandage that stabilizes the oxygen sensor
with contributions from environmental fluctu-
ations to oxygen to be identical across many
measurements. This allowed for sensor cal-
ibration via microcontroller programming in
each wound environment. The authors further
suggested that the printed circuit board used
in their design could be replaced with flexible
PCB and hence provide more feasibility in de-
veloping more complicated designs.
VIII. Additional Sensor Substrate
Materials
Graphene has received a large research inter-
est since its discovery in 2004 by Geim and
Novoselof [30] and by virtue of its high elec-
tron conductivity [31], fast heterogeneous elec-
tron transfer rate at edges of sheets and defects
on the basal plane [32], [33], large surface area
[34], and cheap and simple fabrication [35].
Further, it is suitable for electrochemical appli-
cations such as smart bandage technology [36];
indeed, graphene has already been identified
as holding great potential for electrochemical
sensing and biosensing by [37, 38].
 Smart Bandage Technology
Chee and Pumera [39] compared the per-
formance of chemically-modified graphenes
to glassy carbons and edge plane pyrolytic
graphite using uric acid. The authors found
that thermally-reduced graphene oxide pro-
vided the most sensitive and selective re-
sponse but also found that it was among
the least linear and reproducible. Graphite
oxide, graphene oxide, chemically reduced
graphene oxide and electrochemically re-
duced graphene oxide were found to gener-
ally exhibited higher sensitivity but poorer re-
producibility and selectivity than glassy car-
bons and edge plane pyrolytic graphite. The
authors conclude that applications of these
chemically-modified graphenes for advanced
diagnostics is conceivable. Furthermore, Sa-
hatiya et al. [40] described an approach to
the fabrication of flexible electronics using so-
lar exfoliated reduced graphene oxide (SrGO)
and graphene flakes as the sensing materials
for developing the sensors on a polyimide sub-
strate. With regard to temperature sensing,
both SrGO- and graphene flake-based devices
displayed negative temperature coefficient val-
ues greater than those seen by various com-
mercial sensors, thus indicating graphene on
polyimide can be effectively used as a high
sensitive infrared photodetector and wearable
temperature sensing platform in a clinical set-
ting.
Phair et al. [41] investigated butyl grafted
polyethylene film loaded with carbon as a
mechanically flexible conductive substrate for
electrochemical sensing applications for smart
bandage development. It was concluded that
given the high degree of morphological flex-
ibility present in wound sites, a composite
mesh offers mechanical flexibility sufficient for
purpose and that that the film exhibits the re-
quired electroanalytical properties for use in a
clinical setting. Moreover, other carbon-based
substrates, such as nanotubes and graphene
previously addressed, have financial limita-
tions with regard to material costs and mass
manufacturing that are not present in carbon
loaded polyethylene film. The authors con-
jecture electrochemical mesh modifications al-
lowing for the film to be used for detection of
additional analytes, such as glucose and oxy-
gen.
IX. Proposed Design
In the literature reviewed, common wound
diagnostic markers include used in smart ban-
dage technologies included pH, temperature
and tissue oxygenation; however, a technology
with multiple integrated sensors has not been
investigated. Moreover, the use of carbon-
based substrates such as graphene, carbon
nanotubes or carbon-loaded polymer films,
combined with radio frequency identification
or near-field communications capabilities
would produce a novel technology for clinical
diagnosis. Thus, the following concept has
been generated and is shown in Figures 1 and
2.
Figure 1: Smart Bandage Concept: Expanded View
Figure 1 shows an exploded view of the
bandage, with the hydrogel layer in blue,
a pH sensor on a carbon-based substrate
in green, a oxygen sensor on a parylene
substrate in blue and a temperature sensor
on a carbon-based substrate in red. The final
layer is a self adhesive polymer. Absorption
and porous layers are not shown but may
be included as required. Figure 2 shows the
contracted view of the bandage.
The concept shown in Fig.1 and Fig.2 con-
tains the basic structure of the smart ban-
dage, including the three afore mentioned sen-
sors, utilising carbon-based substrates, such
5
 Smart Bandage Technology
• Mechanically flexible polymer/elastomer
for self-adhesive layer.
Figure 2: Smart Bandage Concept: Contracted View
as graphene and butyl grafted polyethylene,
and polymer-based substrate, such as pary-
lene. Alternative materials, such as vari-
ous chemically-modified graphenes and car-
bon nanotubes may also be considered. Hy-
drogel has been included to mimic the oxygen
permeable skin environment and to simulates
the wound site, as per [29]. The self adhesive
layer is a polymer, such as polyethylene or an
elastomer.
X. Conclusion
A smart bandage proposal has been put for-
ward based on the literature reviewed pertain-
ing to the ideal dressing, potential biomarkers
and current technology, where a potential gap
was identified within current developments of
smart bandage technology. The key features
of this proposal are:
• Three sensors to continuously monitor
pH levels, temperature and wound oxy-
genation.
• Carbon-based substrates, such as
graphene and carbon loaded polyethy-
lene film, for pH and temperature
sensors; parylene substrate for oxygen
sensor.
• NFC/RFI technology for wireless moni-
toring.
6
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