Tunable Hydrogel Electronics for Diagnosis of Peripheral Neuropathy.

Peripheral neuropathy characterized by rapidly increasing numbers of patients is commonly diagnosed via analyzing electromyography signals obtained from stimulation-recording devices. However, existing commercial electrodes have difficulty in implementing conformal contact with skin and gentle detachment, dramatically impairing stimulation/recording performances. Here, this work develops on-skin patches with polyaspartic acid-modified dopamine/ethyl-based ionic liquid hydrogel (PDEH) as stimulation/recording devices to capture electromyography signals for the diagnosis of peripheral neuropathy. Triggered by a one-step electric field treatment, the hydrogel achieves rapid and wide-range regulation of adhesion and substantially strengthened mechanical performances. Moreover, hydrogel patches assembled with a silver-liquid metal (SLM) layer exhibit superior charge injection and low contact impedance, capable of capturing high-fidelity electromyography. This work further verifies the feasibility of hydrogel devices for accurate diagnoses of peripheral neuropathy in sensory, motor, and mixed nerves. For various body parts, such as fingers, the elderly's loose skin, hairy skin, and children's fragile skin, this work regulates the adhesion of PDEH-SLM devices to establish intimate device/skin interfaces or ensure benign removal. Noticeably, hydrogel patches achieve precise diagnoses of nerve injuries in these clinical cases while providing extra advantages of more effective stimulation/recording performances. These patches offer a promising alternative for the diagnosis and rehabilitation of neuropathy in future.

On-skin biosensors for noninvasive monitoring of postoperative free flaps and replanted digits.

Severe soft tissue defects and amputated digits are clinically common injuries. Primary treatments include surgical free flap transfer and digit replantation, but these can fail because of vascular compromise. Postoperative monitoring is therefore crucial for timely detection of vessel obstruction and survival of replanted digits and free flaps. However, current postoperative clinical monitoring methods are labor intensive and highly dependent on the experience of nurses and surgeons. Here, we developed on-skin biosensors for noninvasive and wireless postoperative monitoring based on pulse oximetry. The on-skin biosensor was made of polydimethylsiloxane with gradient cross-linking to create a self-adhesive and mechanically robust substrate that interfaces with skin. The substrate was shown to exhibit appropriate adhesion on one side for both high-fidelity measurements of the sensor and low risk of peeling injury to delicate tissues. The other side demonstrated mechanical integrity to facilitate flexible hybrid integration of the sensor. Validation studies using a model of vascular obstruction in rats demonstrated the effectiveness of the sensor in vivo. Clinical studies indicated that the on-skin biosensor was accurate and more responsive than current clinical monitoring methods in identifying microvascular conditions. Comparisons with existing monitoring techniques, including laser Doppler flowmetry and micro-lightguide spectrophotometry, further verified the sensor's accuracy and ability to identify both arterial and venous insufficiency. These findings suggest that this on-skin biosensor may improve postoperative outcomes in free flap and replanted digit surgeries by providing sensitive and unbiased data directly from the surgical site that can be remotely monitored.

Flexible Hybrid Integration Enabled xsOn-Skin Electronics for Wireless Monitoring of Electrophysiology and Motion.

On-skin electronics are promising in human motion and vital sign monitoring, disease diagnosis and treatment. On-skin systems are soft and stretchable, and can maintain electrical performances during bending, stretching or twisting, etc. However, current integrated circuit based fabrication processes are not compatible with stretchable substrate, and recently proposed flexible hybrid integration methods typically involve complicated fabrication processes or structural design, and do not support high integration density. Herein, we report a series of flexible hybrid integration strategies which endow the on-skin electronics with advantages of high integration density of electric components, facile fabrications, high stretchability and reliability. Proposed strategies include: 1. High I/O density with highly stretchable and conductive composite materials as interconnects; 2. Multi-layer structures enabled by stretchable and conductive via-holes; 3. High reliability approach for chip attachment onto stretchable substrate; 4. Design and fabrication of strain separation structure. Based on these methods, an on-skin flexible hybrid electronic system (FHES) is fabricated to collect electrocardiogram (ECG) and acceleration data, wirelessly transmit and display the data in real time on a mobile phone application through Bluetooth communication. We also verify the accuracy and stability of the FHES through the measurements of ECG and acceleration data from human skin under various conditions. The flexible hybrid integration schemes proposed can be adopted for the development of a variety of on-skin systems for biomedical applications.

Materials, Devices, and Systems of On-Skin Electrodes for Electrophysiological Monitoring and Human-Machine Interfaces.

On-skin electrodes function as an ideal platform for collecting high-quality electrophysiological (EP) signals due to their unique characteristics, such as stretchability, conformal interfaces with skin, biocompatibility, and wearable comfort. The past decade has witnessed great advancements in performance optimization and function extension of on-skin electrodes. With continuous development and great promise for practical applications, on-skin electrodes are playing an increasingly important role in EP monitoring and human-machine interfaces (HMI). In this review, the latest progress in the development of on-skin electrodes and their integrated system is summarized. Desirable features of on-skin electrodes are briefly discussed from the perspective of performances. Then, recent advances in the development of electrode materials, followed by the analysis of strategies and methods to enhance adhesion and breathability of on-skin electrodes are examined. In addition, representative integrated electrode systems and practical applications of on-skin electrodes in healthcare monitoring and HMI are introduced in detail. It is concluded with the discussion of key challenges and opportunities for on-skin electrodes and their integrated systems.