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Systematic Review

A Review of Wearable Electroceutical Devices for Chronic Wound Healing

by
Ali Abba Mutah
1,
Joseph Amitrano
1,
Mark A. Seeley
2 and
Dhruv Seshadri
1,2,*
1
Bioengineering Department, Lehigh University, Bethlehem, PA 18015, USA
2
Orthopedic Research Institute, Geisinger Health System, Danville, PA 17822, USA
*
Author to whom correspondence should be addressed.
Electronics 2025, 14(7), 1376; https://doi.org/10.3390/electronics14071376
Submission received: 14 February 2025 / Revised: 19 March 2025 / Accepted: 24 March 2025 / Published: 29 March 2025
(This article belongs to the Special Issue New Application of Wearable Electronics)
Browse Figures
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Abstract

:
A chronic wound is a wound that fails to progress through the normal stages of healing within a typical time frame, often remaining open and unhealed for more than 4 to 6 weeks. The delayed healing is often associated with comorbidities, and its clinical consequences have posed great concern to patients, caregivers, and researchers. The use of electrostimulation to enhance healing in chronic wounds has received attention in the last 20 years. Innovative wearable electroceutical devices are engineered to enhance the healing of chronic wounds while prioritizing patient convenience. These devices employ controlled micro-electrostimulation to reactivate endogenous bioelectric activities needed for cellular signaling. However, these devices and their mechanisms of electrostimulation have not been fully explored. In this systematic review, three databases with articles published between 2000 and 2023 were searched and screened using strict inclusion criteria while adhering to the PRISMA checklist. We identified direct, pulsed, and alternating electric currents as the primary modalities by electroceutical devices to deliver electrical stimulation in chronic wounds. Typical chronic wounds identified include diabetic foot ulcers, pressure ulcers, and diabetic venous ulcers. Additionally, a few materials crucial for chronic wound healing were reviewed, and recent devices in research were considered in this study. Various devices, including triboelectric and piezo-nanogenerators, were identified for their potential functionalities in generating electrical stimulation relevant to chronic wound applications. The literature lacked closed-loop electroceutical platforms for treatment and concurrent monitoring of wound healing. The analysis taken from this systematic review provides opportunities at the intersection of epidermal soft bioelectronics, wound care, and remote sensing.

1. Introduction

A wound refers to any disruption in the skin’s structural integrity that can result in sepsis or functional limitations within the body. Healing consists of overlapping phases involving cells and factors that come into play for tissue repair. These phases of tissue regeneration begin from hemostasis to inflammation, followed by the proliferation of cells, formation of granulation tissues, and finally, remodeling. Disruption of any of these processes can result in delayed healing, often during the inflammatory phase, leading to the formation of chronic wounds [1].
Depending on the causative factor and healing time, wounds can be classified as acute or chronic [2]. Nearly one billion of the world’s population is estimated to be suffering from acute or chronic wounds [3]. Wound healing has been seen as an active, continuous process by the body to repair damaged tissues. This constant process is essential as interruptions in these processes can negatively impact the patient’s quality of life [4].
Chronic wounds have been reported to affect more than 6 million of the United States population with resultant pain and dysfunction. It is prevalent in 3% of the elderly 65 years and above. United States statistics show that by 2060, the elderly population will be over 77 million, forecasting that chronic wounds will continue to pose a greater risk to the growing populace [5]. The economic impact of chronic wounds in the United States is estimated to be over USD 50 billion per annum [6]. Observations have shown that most chronic wounds are seen in geriatric patients [7]. Chronic wounds usually fail to heal due to a protracted inflammatory stage along the phases of wound healing [8]. Factors such as the etiology, location, size, wound depth, and pathologic nature of the wound are vital healing factors [9]. These wounds can last for 12–13 months on an average scale, with a 70% tendency of reoccurrence. Available treatment options include antibiotic therapy, moist wound healing, debridement, and the use of hyperbaric oxygen, allographs, autographs, and regenerative bioengineered xenographs [10].
Healing in chronic wounds has impacted human health and poses serious public health concerns for patients [11]. Electrostimulation has been defined as the use of a micro-electric current as an adjunct therapy in and around open wounds using electrodes [12]. Wounds negatively impact human health, putting a substantial economic burden on quality of life. Studies revealed this impact to be associated with slow healing rates of wounds [13]. Micro-endogenous tissue electric activity may be lost or truncated in a chronic wound environment due to highly compromised tissue architecture, sepsis, and degeneration, leading to the leakage of ions; re-activation may play a vital role in restoring cellular homeostasis. In the intact human skin, a transcutaneous potential of 20–50 mV and an endogenous electric field are maintained. Active Na/K ATPase pumps within the epidermis generate and maintain the flow of currents generated. Injury leads to the loss of these structures, thereby altering electric field dynamics. Knowledge about these processes has been crucial in developing effective wound-healing strategies [14]. In this regard, electrostimulation appears more relevant in recalcitrant wounds where endogenous electric fields may be absent. The key to improving suitable healing outcomes is reactivating endogenous ions through electrostimulation [15].
The use of electrostimulation over the years has received attention for wound healing [16]. This review seeks to identify key devices in use and under research that utilize one or more forms of electrostimulation to augment healing in wounds. A schematic representation (Figure 1) and the mechanisms by which electrostimulation acts on the different stages of wound healing (Table 1) [17].

1.1. Types of Chronic Wounds

Generally, chronic wounds have been categorized into three types (Table 2), which include diabetic foot ulcers, pressure ulcers, and vascular (arterial and venous) ulcers [18]. Diabetic foot ulcers are associated with diabetic peripheral neuropathy (loss of sensation) in the lower extremities. Pressure ulcers usually arise from prolonged, unrelieved pressure, friction, or compression forces and cause necrosis of skin and underlying tissues, and vascular ulcers originate from faulty valves that lead to venous hypertension from backflow of blood and increased pressure on the vessel wall [19]. Chronic wounds are non-healing and affect the quality of life, leading to limited body function, pain, and morbidity. In severe cases, such wounds can lead to amputation of the affected body part, as seen with a reasonable number of diabetic patients [6]. These are commonly seen among aged individuals and in conditions like diabetes, obesity, and vascular pathologies. Chronic wounds are usually associated with a comorbid disease, which complicates their development and makes them cumbersome to trace and treat [20]. Despite these huge health impacts and high economic catastrophe, effective and efficient treatment options are not readily available [21].

1.2. Electroceutical Therapy and Mechanisms of Action

The introduction of electrostimulation to enhance wound healing was based upon the discovery of endogenous electric fields of about 40–200 mV/mm found in cells of vertebrates [13,22]. With the advancement in technological innovations of wearable devices, successes were recorded with therapeutic electroceutical devices and their applications in the clinics, industry, and military [23]. Some research identified devices that use electric fields to simulate healing by preventing bacterial sepsis, stimulating cell adhesion, migration, and angiogenesis, and harnessing endogenous sodium ion (Na+) and potassium ion (K+) [24] known to facilitate generating and transmitting action potential necessary for tissue functioning.
Studies revealed that the plasma membrane utilizes electrochemical direct current ion exchange. Any disruption to the integrity of the skin surface distorts the electric flow, forming an electric field. This electric field is created along with the host’s body response to an injury involving cellular, chemical (chemokines), cytokines, and growth factors to initiate healing [25]. Keratinocytes were observed to respond to electrostimulation of 100–150 mV/mm for a period of 6–24 h with significant proliferation [26]. Fibroblasts were noticed to migrate slowly toward the anode in response to 50–100 mV/mm [27]. Macrophages and endothelial cells are key cells that react to electrostimulation and have been identified as playing a key role in wound healing. Macrophages are activated early in wound healing to clear debris and pathogens. They transition from M1 (proinflammatory) to M2 (anti-inflammatory) phenotype promoting the secretion of growth factors like VEGF and TGF-beta stimulating angiogenesis and fibroblast activity, which helps remodel the wound [28].
Several types of these electrostimulations have been used in diverse applications, including direct and alternating currents, high-voltage pulsed currents, and low-intensity direct currents [29]. The direct current uses a continuous stream of electrons in one direction (monophasic waveform); usually, a 20–200 µA current can be applied at low voltage. However, a continuous flow can result in an electrothermal effect, which produces considerable heat. This heat can lead to burns in tissues with an electrophysical resultant impact. The voltage, polarity, and exposure duration are important parameters in the direct current [30]. Pulsed current utilizes monophasic or biphasic waveform with currents of 1.2–1.5 mA and can be applied to high-voltage tissues. It has been shown to have lesser electrothermal, electrophysical, and electrochemical side effects than direct current. Pulsed current can be classified based on waveform, amplitude, duration, and frequency [31]. The alternating current has a biphasic waveform with two identical electric pulses alternating with 50–150 V depending on tissue hydration [19]. Alternating currents can be delivered in various waveforms, which can be symmetrical or asymmetrical and not pulsed. Heat and chemical by-products do not accumulate during alternating current application due to cyclic changes in the polarity of the electrodes; however, it is rarely used in wound healing. Electrostimulation and heat energy have been demonstrated to produce a controlled and precise short duration of wound therapy [32]. It has become evident that the pulsed current is better suited for electroceutical devices for chronic wound healing.
Thermal energy emitted from electroceutical devices is considered beneficial, as controlled heat has been demonstrated to stimulate angiogenesis, improve cell anabolism and catabolism, and generally stimulate the microenvironment toward accelerating wound healing. Electrical fields and chemotaxis guide and accelerate cell migration to the injury site. Electrostimulation has been seen to act as a secondary treatment for chronic wounds, as it exerts bacteriostatic and bactericidal effects on bacteria. This is beneficial in reducing bacterial load in wounds [29]. Successes have been recorded with electroceutical devices in many clinical practices, but concerns about unprofessional therapy date back to the use of electric eels in ancient Rome and Greece to stimulate angiogenesis and provide pain relief in bathtubs [29]. Thus, we have seen substantial evidence of leveraging electrostimulation to complement wound healing.
Several commercial devices are currently available, utilizing one or more electrical signals to augment healing in chronic wounds. The POSiFECT®RD (BioFisica™, Odiham, Hampshire, UK, and Atlanta, GA, USA) is a miniature bioelectric device that delivers micro-amperage continuous, direct current for treating venous and pressure ulcers in the United Kingdom. Another device is the Accel-heal, which is a microcurrent electrical stimulator applied to painful and hard-to-heal wounds for 12 days. It mobilizes bioelectric signals from the skin surrounding the wound and establishes electrical activities within the wound bed (Figure 2A). E-Qure’s BST is a non-invasive, pain-free electrotherapy device developed to boost the body’s natural electrical signals. It has been approved for treating chronic wounds such as vascular leg ulcers and diabetic and pressure wounds. The woundEL® is an electric stimulation device that delivers a low-voltage, monophasic, pulsed current waveform. The device comprises a hydrogel contact layer that interfaces with the wound, a carbon and silver conductive middle layer, and a water-repellant layer protecting the dressing. Electrostimulation using this device lasts 20–30 min daily for 2–3 days (Figure 2B). The gekoTM is a small, self-adhesive, wearable device that delivers a gentle electrical pulse per second to the peroneal nerve and is used for improving healing in venous leg ulcers. It has been demonstrated to improve venous, arterial, and microcirculatory blood flow to wound beds, doubling the healing rate in patients. A wireless microarray technology for chronic wound care designed with multichannel electrodes is a smart device that delivers low-intensity electrical stimulation to promote healing (Figure 2C). These devices generally utilize one or more forms of electrostimulation. The mechanism of electrostimulation may include the following: galvanotaxis (electrotaxis), which directs the migration of cells (keratinocytes, fibroblast) to the wound site and promotes tissue repair; angiogenesis, which is the formation of new blood vessels that improves oxygenation and nutrient delivery to tissues; collagen synthesis, which is facilitated by reactivated fibroblast activity leading to increased collagen deposition for wound closure; growth factors such as vascular endothelial growth factor (VEGF) is crucial for tissue regeneration [19,33].
Many electrostimulation devices are currently under research. A wireless, closed-loop, smart bandage coupled with integrated sensors and stimulators was explored by [34] to accelerate healing and advanced wound care. This is a flexible bioelectronic system with skin-interfacing hydrogel electrodes for attachment to the skin. It monitors skin temperature and impedance and delivers electrostimulation relative to the wound environment. Others include piezoelectric and triboelectric nanogenerators designed to deliver micro-electrostimulation to wounds. Some of these devices are designed to harness body kinetics to self-generate power for running the device (Figure 3).

1.3. Role of Wearable Technologies for Chronic Wound Healing

Recent advances in the development of wearable devices utilize various sensing, monitoring, and therapeutic technologies that measure various bodily parameters ranging from physiological to pathological conditions and variations in metabolic processes and institute therapy [38]. Wearable technologies being developed may be a better option for wound healing and monitoring than conventional modalities [2]. Accelerated wound healing has been observed to be promoted by the application of electrostimulation [39]. Photo-stimulation therapy has been beneficial using laser and light-emitting diodes in a process known as photobiomodulation. This has been observed to alleviate pain and inflammation and support wound healing through regeneration [40]. Flexible biosensing devices with multiple functions ranging from wound microbiome and inflammation monitoring, physiochemical profiling, and transmitting data to smartphones have been explored [41]. Strain sensors using stretchable ion gels have been used in wearable and stretch electrochemical devices [42]. Conductive self-healing and self-adhesive composite alginate-based hydrogels have been engineered on flexible devices for strain monitoring [43], polyimide hydrogel textiles [44], and ultra-stretchable double network hydrogels for strain sensor wearable devices [45]. Other devices include moisture sensors for exudative wounds [46,47]. Most conventional wound dressing options, as described above, are seen as passive (bandages), interactive (polymers), advanced (alginates and colloids), and bioactive (biological scaffolds) and may need regular to occasional changes and modifications, interrupting healing wound beds, leading to lags in tissue regeneration and healing [48,49]. These devices are designed to provide users with comfort but may be associated with some disadvantages. Potential side effects of electrostimulation may include burns or skin irritations, pain and discomfort, tissue damage, infection, and possible interference with implanted devices like pacemakers.

1.4. Research-Grade Devices

Bioelectronic devices with several features and components have been used in various medical applications [50]. Existing devices have limitations in offering detailed information for effective research [51]. Current technological advancements integrate conventional, smart bandages exploring diverse materials and bioelectronic devices for wound monitoring and healing (Figure 3) [52]. Despite significant advances made with wearable devices, significant setbacks exist in meeting specific healthcare requirements for therapeutic utilization [53]. These impediments could include reliance on batteries, which may limit long-term usability. Triboelectric and piezoelectric nanogenerators need to be optimized for consistent and reliable power output. Concerns regarding allergies and skin irritations may cause discomfort. Accuracy in bioelectric signal measurement is crucial and may be compromised due to movement or sensor placement.

1.5. Standard of Care and Gaps

Traditional wound care involves debridement, which is the removal of non-viable tissues. This is carried out through surgical, autolytic, or enzymatic means to allow healthy tissue to proliferate, repopulating the wound bed [54]. However, debridement is limited to specific wound types, locations, and timing and may not adequately stimulate chronic wound healing. The use of skin substitutes, especially from autologous and bioprosthetic sources, has been explored in burn and surgical defects for large wounds [54]. A variety of commercial grafts, such as biobrane, trancyte, EZ derm, and dermagraft, with cells such as fibroblasts incorporated with collagen and various cytokines to stimulate healing, have been explored [54,55,56]. Despite the successes achieved with these materials, material sourcing, cost, and surgery for tissue replacement impede success.
The need for an improved and systematic healthcare system to meet the needs of patients is of great value [57]. Interventions are being implemented to improve the quality of healthcare service delivery. These include setting standards, changing approaches to clinical practices, and using quality improvement programs and methods (World Health Organization, World Bank Group, OECD, 2018 [58]).

1.6. Review Objective

This systematic review aims to identify specific electroceutical devices that utilize electrostimulation to enhance chronic wound healing clinically and to identify the technological innovations used and their operational modalities.

2. Materials and Methods

This study followed the guidelines of the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) checklist [59], sections 20–22. The review topic was inputted into the PROSPERO register, and no match was found for our topic of interest. However, the review was not registered, and no protocol was prepared. A literature search was conducted on studies published from 2000 to 2023. Search engines and databases explored include Google Scholar, PubMed, and ScienceDirect using the following significant keywords: wearable devices used for wound healing, wearable technologies used in wound healing, bioelectronic devices used for wound healing, electroceutical devices used for wound healing, and any related technology of interest that meets the authors’ inclusion criteria. No automation tool was employed during the screening process. Article search and review were carried out independently by reviewers (2) to avoid bias. Inclusion criteria for published articles considered in this review are specific to electroceutical/bioelectronic devices that harness electrostimulation to complement the healing process in chronic wounds. Exclusion criteria to screen articles include wearable devices for monitoring body physiological and biochemical markers, devices delivering medication for external and systemic infections, devices that utilize wound healing modalities without electrostimulation, and wearable electroceutical devices for acute wound healing. Titles and abstracts were screened to avoid duplicity, conference proceedings and unpublished studies were reviewed to minimize publication bias, and those with data relevant to this review were included.

3. Results

Electroceutical and bioelectronic devices identified in this review utilize one or two direct, alternating, or pulsed currents to deliver controlled tissue-tolerable electrostimulation to augment chronic wound healing. Most identified devices work on the basic principle of stimulating cellular signaling and angiogenesis to reactivate the stalled inflammatory phase of chronic wounds. A literature search on three web sources (Google Scholar, PubMed, ScienceDirect) identified 2235 related articles explored during this review (Table 3), considering our inclusion criteria. Out of these, 172 were identified as duplicates, while 2063 were screened for eligibility, of which 1874 were excluded. While 189 articles were found to mention the use of bioelectronic devices, only 29 were found to utilize electrostimulations for wound healing. The literature search further identified 1283 devices for monitoring physiological and pathological conditions. Further screening identified 382 devices as photo-biomodulators that complement wound healing; however, they do not rely on generating direct, pulse, or alternating electric flows for wound healing. Then, 208 were further identified as smart bandages/devices made of materials that deliver medications for wound healing, while 317 devices were identified with polymeric components for wound care and medication delivery. Further screening identified 12 devices as biochemical sensors for monitoring chemical activities in the body systems. Two devices work on the principle of applying negative pressure to the wound area to induce healing. An additional 2 devices work on the principle of thermotherapy using heat to maintain wound bed, provide warmth, and create an optimum condition for cells to thrive. The variability of results in the included study was evaluated for methodological quality and consistency of findings. The focus was placed on interventions and outcomes, and the precision of effect estimates was considered based on sample size. The PRISMA flow chart (Figure 4) shows the flow of information through the different phases used in this study. Specific types of devices, the currents they generate, their stimulation patterns, and their effects on wound healing were highlighted, along with relevant findings from selected literature (Table 4).

4. Discussion

Electrostimulation has been demonstrated to proffer solutions to chronic wound healing by leveraging micro-electric stimulatory effects on cells and tissues, promoting wound repair and regeneration. Fibroblasts, epidermal cells, macrophages (M2), growth factors, and neural cells have been demonstrated as major players in facilitating repair via electrostimulation. This review highlights key wearable electroceutical devices that impact chronic wound healing using electrostimulation. These wearable devices have been demonstrated in the laboratory, pre-clinical, and some human clinical trials, with successes reported. However, translation and scaling these devices for clinical use remain a challenge.
The trend from traditional to innovative wound healing devices began with the development of flexible smart bandages engineered to deliver medications to chronic wounds to bridge the gap between inflammation and the proliferative phase of wound healing, stalling the inflammatory phase, which has received much-needed attention over the past years [51]. Various types of bandages have been developed to improve different wound conditions, such as dryness, exudation, gangrene, and dirty, infected, superficial, or deep non-healing wounds, but are commonly associated with certain limitations [69]. Factors contributing to wound repair need to be incorporated into the design of devices to promote optimal healing for chronic wounds. These include wound nutrition, hydration, oxygenation, hygiene, electric stimulus, and general wound care [70]. The ideal wound dressing and technology is expected to create a clean, warm, and sepsis-free environment while maintaining perfusion and nutrition, among other necessary conditions that protect healthy wound beds from mechanical forces that may perturb granulation tissue formation during the proliferative phase of wound healing [69]. The development of flexible and conforming bandages engineered with innovative technologies to regulate wound temperature, oxygen, moisture, and pressure, as well as the incorporation of materials that can conform to different wound surface topographies and allow optimal healing conditions, has been explored. These technologies now include several modalities of wearable electronic devices designed to generate and deliver electrostimulation for chronic wounds [51].
Engineered dressings are expected to maintain moisture, promote cellular migration, ensure optimum tissue perfusion, protect against infection, and be non-adherent and easy to change [71]. Occlusive dressings recently gained momentum, contributing to 40% re-epithelialization of partial thickness wounds. Important factors under consideration include wound pH, moisture retention, cell perfusion, collagen synthesis, enhanced signaling of growth factors, and epithelial tissue keratinization [72]. It was earlier perceived that wounds dressed in occlusive bandages may lead to increased bacterial load; however, better outcomes were noticed than non-occlusive bandages. Another essential feature of these bandages is their ability to conform to body contour and remain adherent despite mechanical distortions [71]. Introducing transparent gauzes and films marks the evolution of advanced bandages for chronic wound healing. They have been essential in maintaining wound moisture, tissue perfusion, oxygenation, and prevention of bacterial contamination, which has been explored in the treatment of chronic wounds [73]. Recently, optical transparent bandages have gained attention, as biomedical engineers can now electrospin materials made of transparent material with better properties for wound dressings. These film dressings are considered semi-permeable because they allow moisture to diffuse across wound beds while remaining impervious to water and bacterial contamination [65]. Excellent wound dressing properties associated with these materials can be harnessed and incorporated into wearable electroceutical devices, creating a synergy for optimal chronic wound healing.
With the recent interest in exploring electroceutical devices for wound healing, the definitive mechanism through which healing is achieved remains controversial, unresolved, and an active research area. We identified key devices that fit our search criteria and highlighted some basic principles on how these devices complement wound healing. Within the scope of this review, the types of electrostimulation devices identified were alternating (AC), direct (DC), low pulsed current, high-voltage pulsed current, and pulsed electromagnetic fields [68]. Most pulsed and direct currents applied mainly activate galvanotaxis [74]. Galvanotaxis is a feature observed with keratinocyte clusters, which migrate toward the wound along the potential gradient, usually attracted by negatively or positively charged cells toward an electric field with opposite polarity [75]. This phenomenon influences the migration of cells and promotes re-epithelization [76]. It becomes apparent that most wearable electrostimulation devices are supplementary in managing chronic wounds, taking advantage of the body’s endogenous electric field to promote the repair and regeneration of affected tissues. Despite successes made, it appears that there is no ideal device for chronic wound treatment [19].
Applying direct current for chronic wounds promotes healing, and a more significant percentage of identified devices use direct current. The EGS model 300 electrical stimulators use a pulsed direct current to stimulate fibroblast proliferation and migration [60]. This appears vital for wound healing as fibroblasts were identified as cells that promote collagen deposition during wound healing, which is essential. Collagen is a known structural protein that supports the ECM and serves as mechanical support. Electrostimulation was seen to stimulate the alignment of collagen fibrils and promote the conversion of type III to type I collagen fibrils [17]. Immune activation during the inflammatory phase of wound healing influences the migration of fibroblasts and epithelial and endothelial cells [20], and collagen dressings have been developed to target chronic wounds due to their functional mechanism to delay protein and electrolyte loss in wound exudate, preventing bacterial contamination and improve healing [77].
The DDCT device utilizes direct and alternating currents to stimulate existing electrical activity in tissues. Some alternating currents generated activate cutaneous sensory nerves [76], which may play a significant role in tissue repairs by augmenting blood flow and sensitivity of tissues in the wound area [68]. Stimulation increases their capacity to elicit cell signaling and migration to the wound area more efficiently. The DDCT device was demonstrated to be effective in stimulating accelerated wound contraction during clinical trials [61].
A wireless closed-loop smart bandage by [34] represents an advanced therapeutic platform tailored for treating and monitoring chronic wounds. This miniature, dual-channel device incorporates stimulation and sensing mechanisms for real-time wound management. It employs highly sensitive impedance sensors that continuously monitor wound bed electrical activities, providing data on cellular activities, tissue hydration, and the integrity of the wound extracellular matrix. Additionally, temperature sensors detect variations in wound bed temperature. The combined feature assists in providing real-time data crucial for tailoring interventions to accelerate healing trajectories. This dual-channel device delivers low-intensity, precise electrostimulation mimicking endogenous bioelectric signals, re-establishing truncated electric fields, and promoting cellular migration, angiogenesis, and tissue repair [34]. This device was observed to accelerate wound healing through a pro-regenerative mode of action, recruiting and proliferating cells, specifically macrophages, for wound repair. Macrophages (M2) are often regenerative and associated with wound healing. Thus, it may be possible that electrostimulation enhances the recruitment of M2 macrophages in wounds to initiate healing. Electrostimulation is known to modulate macrophage polarization through calcium ion flux, and cytokine profiles. Calcium ion is a well-known messenger of macrophage activation, favoring M2 polarization. Fibroblasts and keratinocytes are known to release IL-4 and IL-13, which promote M2 activities [78].
The ACEF was designed to provide electrostimulation to cells in a non-contact mode. In this system, 58 mV/mm ACEFs with frequencies of 10, 60, and 110 Hz were directed at epidermal cells, fibroblasts, and macrophages [64]. These frequencies promoted the proliferation of dermal fibroblasts, epidermal keratinocyte cell lines, and polarization of M2 macrophages. Healing was observed to improve without the risk of secondary damage to tissues. Studies by Barman and Jhunjhunwala showed the increased expression of Spp1 mRNA, a gene representing the presence of an anti-inflammatory M2 phenotype, under the influence of direct electrostimulation treatment for two hours, which verified that macrophages are indeed responsive to electrical cues [79].
A flexible ePatch, made with silver nanowires (AgNW) and methacrylate alginate as electrodes, was used to improve wound management. A silver nanowire, methacrylate alginate, and calcium bio-ink were layered onto a silicone sheet using a template. The template was removed after solidification resulting in a flexible ePatch. Silver nanowire is highly conductive and has antibacterial properties. The methacrylated alginate is highly moisture-retentive and biocompatible. The silver and modified alginate were combined to create a flexible, printable, or bio-ink. Calcium combined with alginate promoted signaling cues for cellular migration. This device was designed to overcome most electrostimulation devices’ rigidity and poor conformation to wound surfaces. This ePatch enhanced angiogenesis and promoted wound re-epithelization; it also enhanced immune response, cell proliferation, and migration in response to electrostimulation [66]. This work demonstrated the possibility of incorporating polymers into smart devices to improve the delivery of electrical signals to tissues and cells.
The BST device identified in this review employs alternating current and stochastic resonance to achieve its function. This device is handy and provides a pain-free therapy that effectively relieves pain. Healing (in 87% of wounds) using this device was achieved in an average of 97 days, while 45% of treated patients reported the absence of pain after 7 days of therapy [68]. The application of stochastic resonance for the management of painful diabetic neuropathy (PDN) achieved significant success in providing pain relief in patients with long-standing diabetes mellitus [80]. Chronic wounds, such as foot ulcerations, are usually associated with diabetic neuropathy. A randomized trial by William et al. using 10 KHz spinal cord stimulation revealed promising improvement in PDN patients. Here, the combination of stochastic resonance with electronic circuits improved healing outcomes.
Chronic wounds are poorly supplied with blood, essential for nutrition and tissue respiration. The need for angiogenesis or neovascularization at the chronic wound site is critical in facilitating chronic wound healing, usually stalled at the inflammatory stage [81]. Xi Ren et al. (2019) [82] used a DC electric field electrode generator to stimulate an endogenous electric field that targeted keratinocytes. Keratinocytes are responsible for secreting keratin, maintaining skin toughness, and promoting wound healing. Keratin forms the topmost part of the stratum corneum, which is responsible for keeping our skin integrity and being the first-line barrier against threats [19].
The wearable piezo-triboelectric nanogenerators identified in this study utilize the body’s mechanics to generate electric signals channeled toward wound healing. Flexible piezoelectric films harness the bending movements produced by the body to generate electric signals. Electric signals emitted from the piezoelectric crystal have been shown to stimulate fibroblast migration and vascularization at wound sites [63,65,67]. Various electroceutical devices identified in this review wholly or partly play a vital role in wound healing by complementing the body’s natural reparative mechanism. The use of electrostimulation holds promise for enhancing healing in chronic wounds, and the various technological improvements and innovations identified in this review are but a few examples of numerous versions under research and development. Utilizing materials such as smart bandages for improved wound dressings has demonstrated the effectiveness of combining electrostimulation and other dressings for efficient chronic wound care and personalized therapy.
These devices are subject to regulation by the Food and Drug Administration (FDA), European Medicines Agency (EMA), or other regulatory agencies to ensure they are safe, effective, and meet regulatory requirements. Additionally, the appropriate classification of these devices can impact the regulatory pathways. Robust clinical trials are needed to demonstrate effectiveness, which may require time and cost. These could be some key setbacks impeding the use of electroceutical devices in mainstream healthcare.

5. Conclusions and Future Directions

Personalized therapy and chronic wound healing are potential applications of wearable electroceuticals. Electrostimulation helps revive the tissue’s natural micro-electric activity, which is necessary to restore cellular processes. More studies are required to maximize their efficacy for clinical translation, user uptake, and implementation. Further development is needed for wireless and potable bioelectronic devices and nanogenerators, as most patients with chronic wounds are not physically active and have comorbidities, making it impossible for them to produce the necessary mechanical activity to activate these devices. Pulsed current is the most recommended method for activating bioelectric signals among the three most often used electrostimulation modalities, as it has been found to have less of an impact on electrothermal, electrophysical, and electrochemical processes.
Next-generation wearable technologies for chronic wound healing should be designed to bridge gaps in present wound dressing options, as chronic wounds remain a burden to the healthcare system. Challenges in engineering solutions to facilitate chronic wound healing are not only limited to caregivers and biomedical engineers but remain a critical health challenge to patients, with significant costs for chronic wound care, including the financial burden of prolonged hospital stays and dysfunction to patients. Integrating wearable bioelectronic devices with materials that support chronic wound healing is essential.
Given enhancing material properties, incorporating modalities to facilitate moisture retention and gaseous exchange is a key feature of wound dressing materials, as several research studies have shown how moisture supports healing by creating a suitable environment for cell migration, proliferation, and differentiation. Several current research sources have focused mainly on incorporating biological cues into dressings, but they still face limitations in achieving the desired goal. As much still needs to be done, wearable technology for wound healing is still in its infancy stage, as only a few have been rolled out for clinical trials, with several of these being engineered at laboratories and yet to be certified for clinical trials.
Future integration of artificial intelligence (AI) into smart wound healing devices may enhance their potential to predict healing outcomes. By leveraging real-time sensor data with machine learning algorithms, complex biological signaling can be analyzed efficiently to achieve personalized therapy for chronic wound healing. AI has been utilized to automate the classification, measurement, and identification of chronic wound healing stages and predict healing times. Machine learning models have been used to predict healing outcomes, and innovative methods like the HealNet have been developed to classify healing stages using self-supervised learning. Deep learning has been utilized to analyze collagen fibers in wounds, predicting the progression of wound healing [83,84,85].

Author Contributions

The manuscript was written through the contributions of all the authors. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. A schematic representation detailing the mechanistic pathway of electrostimulation to enable wound healing. The application of electrostimulation to chronic wounds promotes the re-activation of naïve cells (fibroblasts, endothelial cells, keratinocytes) and endogenous electric activity, enhancing ion exchange (Na+, K+, etc.) that drives healing cascade toward regeneration and wound closure. Created with BioRender.com.
Figure 1. A schematic representation detailing the mechanistic pathway of electrostimulation to enable wound healing. The application of electrostimulation to chronic wounds promotes the re-activation of naïve cells (fibroblasts, endothelial cells, keratinocytes) and endogenous electric activity, enhancing ion exchange (Na+, K+, etc.) that drives healing cascade toward regeneration and wound closure. Created with BioRender.com.
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Figure 2. Industry-grade devices for chronic wound healing: (A) POSiFECT® RD applies bioelectric continuous, direct currents (micro-amperage) to chronic wounds to mimic those generated by normally healing wounds. It is a miniature battery-powered device for venous and pressure ulcers in the United Kingdom (wound-UK.com). (B) The woundEL®, an LVMPC device delivers low-voltage pulsed current to stimulate the healing cascade. The LVMPC device (Goöteborg, Sweden) is an electrostimulation system designed to accelerate the healing process and reduce pain related to wounds (https://www.woundel.com/en/accueil/19-woundel-device.html (13 February 2025). (C) The geko device is a small-in-size, self-adhesive, wearable neuromuscular electrostimulator that is applied to the surface of the skin. It is an adjustable stimulatory device used for hard-to-heal venous leg ulcers that increases blood flow and decreases the chances of thromboembolism (https://www.gekodevices.com/ (10 October 2024)).
Figure 2. Industry-grade devices for chronic wound healing: (A) POSiFECT® RD applies bioelectric continuous, direct currents (micro-amperage) to chronic wounds to mimic those generated by normally healing wounds. It is a miniature battery-powered device for venous and pressure ulcers in the United Kingdom (wound-UK.com). (B) The woundEL®, an LVMPC device delivers low-voltage pulsed current to stimulate the healing cascade. The LVMPC device (Goöteborg, Sweden) is an electrostimulation system designed to accelerate the healing process and reduce pain related to wounds (https://www.woundel.com/en/accueil/19-woundel-device.html (13 February 2025). (C) The geko device is a small-in-size, self-adhesive, wearable neuromuscular electrostimulator that is applied to the surface of the skin. It is an adjustable stimulatory device used for hard-to-heal venous leg ulcers that increases blood flow and decreases the chances of thromboembolism (https://www.gekodevices.com/ (10 October 2024)).
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Figure 3. Electrostimulation technology in research. (A) Multiplex biosensing and miniaturized bioelectronic system for wounds; a schematic wearable patch for chronic wounds on a diabetic foot; fingertip-sized miniaturized wearable patch for electrostimulation with an anti-inflammatory and anti-microbial hydrogel layer. They are designed to deliver micro-electric stimulation and provide anti-sepsis to healing wounds [35]. (B) A model design concept of a self-assisted wound healing device based on piezoelectric and triboelectric nanogenerators highlighting the activation of cells for enhanced wound healing [36]. (C) Electrostimulation (ES) and wound dressing using Chitosan-Vaseline® gauze (CVG) together with a flexible electrostimulation (ES) device [37].
Figure 3. Electrostimulation technology in research. (A) Multiplex biosensing and miniaturized bioelectronic system for wounds; a schematic wearable patch for chronic wounds on a diabetic foot; fingertip-sized miniaturized wearable patch for electrostimulation with an anti-inflammatory and anti-microbial hydrogel layer. They are designed to deliver micro-electric stimulation and provide anti-sepsis to healing wounds [35]. (B) A model design concept of a self-assisted wound healing device based on piezoelectric and triboelectric nanogenerators highlighting the activation of cells for enhanced wound healing [36]. (C) Electrostimulation (ES) and wound dressing using Chitosan-Vaseline® gauze (CVG) together with a flexible electrostimulation (ES) device [37].
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Figure 4. PRISMA flow chart detailing screening processes for literature selection.
Figure 4. PRISMA flow chart detailing screening processes for literature selection.
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Table 1. Effects of electrostimulation on various stages of wound healing [17].
Table 1. Effects of electrostimulation on various stages of wound healing [17].
PhaseEffects of Electrostimulation
InflammatoryEnhanced phagocytosis by neutrophils and macrophages
Inhibited bacteria proliferation and limited sepsis formation
A short inflammatory phase
ProliferativePromotion of the migration, proliferation, and differentiation of keratinocytes, fibroblasts, and endothelial cells and enabling of granulation tissue formation
Extracellular matrix deposition with proteins such as collagen, proteoglycans, and glycosaminoglycans to facilitate repair
RemodelingCollagen fibril alignment
Transformation of type III collagen to type I collagen
Table 2. Chronic wound types and their pathophysiology.
Table 2. Chronic wound types and their pathophysiology.
Wound TypePathophysiology
Diabetic foot ulcersLoss of sensation (diabetic neuropathy) in the lower extremities of the body
Pressure ulcersProlonged pressure, compression, or friction of a body part leading to skin and tissue necrosis
Vascular ulcersEmboli and ischemic ulcers narrow the arterial lumen (arterial ulcers). Venous hypertension is caused by faulty valves, which cause blood to backflow and increase the pressure of the venous wall (venous ulcer).
Table 3. Categories of devices based on functional use and associated number of mentions in literature.
Table 3. Categories of devices based on functional use and associated number of mentions in literature.
TypesDefinitionNumber of Mentions
Smart bandage devicesMedication delivery/wound care and debridement208
Smart polymer devicesWound care, medication delivery317
Electric stimulatorsUses (direct, pulsed, alternating) electric current to stimulate healing29
Light stimulatorsPhoto-stimulation382
Negative pressure wound therapyRegulates air pressure on wound surfaces2
Wound physical parameters sensorsPhysiologic parameter monitoring1283
Thermo-responsive devicesUtilizes heat energy2
Chemical sensor devicesBiochemical parameter monitoring12
Total2235
Table 4. Wearable devices identified within review items.
Table 4. Wearable devices identified within review items.
Type of DeviceType of Current GeneratedStimulation PatternEffectsResultsRef
EGS Model 300 Electrical StimulatorsHigh-voltage pulsed currentMicrostimulation of cells, cell proliferation and migration to wound sitesCell electrotaxis, wound contractionReduction in chronic wound surface area[60]
Decubitus Direct Current Treatment
(DDCT)		Direct/alternating
current		Wound electric activity stimulation and re-activationWound contraction and remodeling Wound contraction rate significantly improved[61]
Wireless closed-loop, smart bandage with sensors and stimulatorsDirect currentRe-activation of vascular endothelial growth factor (VEGF)Pro-regenerativeSignificant increase in wound impedance,
angiogenesis		[34]
Self-powered
TENG		Direct currentEndogenous electric field stimulation and re-activation from micro-electric current generated from friction by materials Inhibition of bacterial proliferation/cellular activation for wound healingFibroblast/EC migration, proliferation, angiogenesis[62]
Wearable piezo-triboelectric nanogenerator devicePiezo and triboelectric
(direct current)		Biomechanical electric impulse generatorEndothelial cell and fibroblast activationEndothelial cell/fibroblast migration[63]
Alternative capacitive electric field (ACEF) exposure systemACEFAlternative capacitive electric fieldKeratinocytes,
dermal fibroblast, macrophages		Cell polarization, enhanced cell activity, proliferation, and migration[64]
Interdigital array (IDA) electrode (TENG)Triboelectric nanogeneratorA direct current electric stimulator from frictional forces generated from materialsVascular endothelial growth factor (VEGF), CD31 markerEnhanced wound vascularization[65]
Flexible ePatch, silver nanowire (AgNW) methacrylate alginatePulsed currentCurrent stimulated by compressional forcesAntibacterial, angiogenesis, cell proliferation, re-epithelizationFibroblast,
endothelial cell electrotaxis, immune cell modulation		[66]
Poly
(l-lactic acid)/Vit. B2-based piezoelectric device		Pulsed currentPiezoelectric generator activation by mechanical dynamics of body movementCollagen deposition,
re-epithelization,
neovascularization,
increased growth factor concentration in wounds		Fibroblast proliferation and migration[67]
Bioelectric Signal Therapy (BST) deviceAlternating currentLow-frequency (2 Hz) periodic pulse sequencePain relief, wound contractionActivation of cutaneous sensory nerves[68]
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Mutah, A.A.; Amitrano, J.; Seeley, M.A.; Seshadri, D. A Review of Wearable Electroceutical Devices for Chronic Wound Healing. Electronics 2025, 14, 1376. https://doi.org/10.3390/electronics14071376

AMA Style

Mutah AA, Amitrano J, Seeley MA, Seshadri D. A Review of Wearable Electroceutical Devices for Chronic Wound Healing. Electronics. 2025; 14(7):1376. https://doi.org/10.3390/electronics14071376

Chicago/Turabian Style

Mutah, Ali Abba, Joseph Amitrano, Mark A. Seeley, and Dhruv Seshadri. 2025. "A Review of Wearable Electroceutical Devices for Chronic Wound Healing" Electronics 14, no. 7: 1376. https://doi.org/10.3390/electronics14071376

APA Style

Mutah, A. A., Amitrano, J., Seeley, M. A., & Seshadri, D. (2025). A Review of Wearable Electroceutical Devices for Chronic Wound Healing. Electronics, 14(7), 1376. https://doi.org/10.3390/electronics14071376

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