Perspectives on the future of skin-prosthetic interactions

Skin is filled with a rich network of sensory neurons, and consequently skin interaction with, and perception of the external environment, is a continual phenomenon experienced by all people in society. For medical devices such as prosthetics, the mechanical interaction between skin and the device is an essential aspect for device function, but it must be minimized to ensure continued skin health, which is inherently intertwined with biological processes. Numerous factors influence the interface properties of skin. For example, hydration, which influences skin morphology and composition, in turn influencing skin mechanics that may lead to tissue inflammation and skin injury. Here, we review the current state-of-the-art in skin medical device tribology with a particular focus on skin-prosthetic interactions. We split this article into traditional approaches to skin friction and a biology-first approach to skin friction, with a paradigm shift of skin as an engineered material. The field of tribology has historically been an interdisciplinary field comprising engineers, chemists and physicists, but future developments are needed in skin biology to drive meaningful change. We envisage that the integration of both clinical and biological perspectives will drive future innovations towards improved medical device interactions with the skin, when paired with engineering perspectives.