Wound management, healing, and early prosthetic rehabilitation: part 2 - a scoping review of physical biomarkers

BACKGROUND:
The timely provision of load-bearing prostheses reduces healthcare costs and mortality risk post-amputation. However, determining readiness for a prosthesis remains subjective, highlighting the need for objective biomarkers to assess healing and prevent further damage to the residual limb.
OBJECTIVE(S):
This review aimed to identify predictive, diagnostic, and indicative physical biomarkers of healing of the tissues and structures found in the residual limbs of adults.
METHODOLOGY:
A scoping review was undertaken following the JBI and PRISMA-ScR guidance. Comprehensive searches using the terms “biomarkers”, “wound healing”, and “amputation” were conducted on Web of Science, Ovid Medline, Ovid Embase, Scopus, Cochrane, PubMed, and CINAHL databases. Key article inclusion criteria included: 1) References of biomarkers and healing; 2) Healing of residuum tissue; 3) Clear/repeatable methodology with ethical approval. Included articles were assessed for quality of evidence (using the QualSyst tool) and level of evidence (using the JBI classification system).
FINDINGS:
Of 3,306 articles screened at the title and abstract level, 219 met the eligibility criteria for data extraction. 77% of included sources were deemed of strong quality. Repeated physical biomarkers included histological evaluation (29% of sources), ABI (11%), oxygen measures (9%), perfusion (6%), and pulse measures (2%). 29% of sources used chemical biomarkers only.
CONCLUSION:
Due to the influence of comorbidities and measurement locations on biomarker levels, no single biomarker can effectively indicate, predict, or diagnose healing; instead, a combination of markers should be used to enhance the objectivity of healing assessments. Despite extensive research, most biomarkers, except routine blood markers, are not utilized in clinical practice, emphasizing the need for efforts to integrate these markers into clinical settings and advance measurement techniques to bridge the gap between bench research and clinical application.