Thermotherapy for Chronic Wounds: A Wound-Interface Translation Framework for Materials, Devices, Clinical Evidence, and Validation Requirements

Interest in local warming for chronic wound care has re-emerged as flexible heaters, embedded sensors, and smart dressings make controlled heat delivery increasingly feasible. This narrative translational review treats thermotherapy as a dose-dependent wound-interface intervention rather than a single warming technology. It distinguishes normothermic radiant warming, water-filtered infrared A, resistive Joule heating, photothermal systems, and temperature-monitoring technologies by mechanism, thermal context, therapeutic purpose, and evidence level. The review integrates wound pathophysiology, biological responses to temperature, thermal-dose concepts, emerging heater platforms, sensing and closed-loop control, clinical evidence, safety, and regulatory translation. Direct human treatment evidence remains concentrated in small historical radiant-warming and water-filtered infrared A studies, with limited additional local-heat evidence, and cannot be transferred directly to contemporary flexible, wireless, or photothermal platforms. For lower-temperature warming, heater setpoint alone is an inadequate dose descriptor, and the biological meaning of cumulative equivalent minutes at 43 °C (CEM43) has not been validated; measured time–temperature profiles, peak temperature, spatial variation, sensor location, and uncertainty are more informative. Clinical translation therefore depends on reproducible wound-interface dosing under realistic moisture, pressure, perfusion, dressing, motion, and workflow conditions, together with wound-specific dose models, transparent reporting, realistic interface validation, and architecture-specific regulatory evidence.