Biosensor Technologies and Smart Dressings for Chronic Wound Monitoring: A Systematic Review

Chronic wound assessment remains largely subjective and time-consuming. Although advances in biosensors and smart dressings enable objective, continuous monitoring of key parameters, with earlier detection of complications and improved efficiency in wound management, their translation into clinical practice remains limited. This systematic review synthesises current evidence on advantages, barriers and facilitators influencing the adoption of biosensor-based and smart dressing technologies for chronic wound monitoring, using an implementation science perspective. A systematic search of PubMed and Scopus (launched on October 30, 2025) identified peer-reviewed clinical studies assessing biosensors or smart dressings for chronic wound monitoring. Two blinded reviewers independently conducted study selection and data extraction per PRISMA guidelines. Eligible studies included adults with chronic wounds, technologies measuring physiological or biochemical wound parameters and outcomes related to usability, advantages, barriers or implementation processes. Data were synthesised using a narrative and thematic approach. The protocol was prospectively registered on the Open Science Framework (OSF) on October 24, 2025 (Registration DOI: 10.17605/OSF.IO/QVMKY). The six included studies (n = 122 participants) evaluated a wide range of technologies, including temperature sensors, plantar stress systems, bioimpedance arrays, pH/oxygen luminescent biosensors and a smart dressing detecting matrix metalloproteinase-9 (MMP-9). Reported advantages included high sensor accuracy, usability, continuous monitoring capability, non-invasiveness, remote data transmission and potential for early detection of wound deterioration. Key barriers comprised incomplete data acquisition, technical malfunctions, workflow complexity, learning curves for users and safety concerns (e.g., nanoparticle cytotoxicity). Key facilitators were wireless connectivity, washable and flexible materials, automated cloud-based alerts, wound-specific design and compatibility with existing wound care protocols. Current evidence remains limited by small sample sizes, technological heterogeneity and implementation barriers. Future research should prioritise large pragmatic trials, evaluating clinically meaningful endpoints and cost-effectiveness, regulatory-grade clinical validation, EHR and telemedicine interoperability, validated patient-reported outcomes and AI-enabled personalised monitoring to support translation into routine clinical practice.