A clinically aligned multimodal workflow framework for chronic wound assessment: An evidence-informed conceptual...

To develop an evidence-informed, clinically aligned multimodal workflow framework for chronic wound assessment and to identify cross-study patterns in image-based artificial intelligence (AI) applications that inform its design.

We conducted a structured evidence mapping and synthesis of published studies on image-based AI for chronic wound assessment. Records were identified through a structured database search and a targeted supplementary search performed during revision. Studies were screened using predefined eligibility criteria, and data were extracted on wound types, image-acquisition approaches, task domains, model architectures, performance measures, and deployment-related characteristics. Cross-study patterns were then used to construct a conceptual workflow framework spanning wound localization, segmentation, clinical interpretation, and longitudinal monitoring.

A total of 44 studies were included in the final analysis. The evidence base was dominated by diabetic foot ulcer and general chronic wound imaging studies, with more limited representation of pressure injury, venous or vascular wound, and postoperative wound contexts. Camera-based acquisition was the most common imaging approach, while device-based and mobile-based acquisition were less frequently represented. When mapped to workflow-relevant task domains, classification/clinical interpretation and segmentation/measurement were the most strongly represented components, whereas localization/detection and monitoring/prediction were less consistently developed. Cross-study patterns also showed increasing representation of clinically meaningful interpretation tasks, including wound grading, tissue characterization, and infection/ischaemia recognition, as well as emerging use of explainability methods in wound-image analysis. These patterns informed the development of a four-stage clinically aligned multimodal workflow framework for chronic wound assessment.

Current wound-AI evidence supports a workflow-oriented conceptual model in which wound localization, segmentation, clinical interpretation, and longitudinal monitoring can be organized into a clinically meaningful assessment pathway. The proposed framework is intended as an evidence-informed conceptual structure to guide future multimodal system development, translational research, and prospective validation in real-world wound care settings.