Advanced medical textiles: from passive implants to intelligent therapeutic platforms

Medical textiles have evolved from passive gauze and sutures into intelligent, biointegrated platforms capable of sensing, responding, and regenerating. However, existing reviews typically focus on single application areas (e.g. drug delivery or wound dressings), leaving a gap in integrated frameworks that connect materials design, fabrication, sensing, and closed-loop therapeutic action. This review provides a comprehensive, critical analysis across the entire translational pipeline, from stimuli-responsive polymers and conductive nanomaterials to electrospun scaffolds, wearable e-textiles, and theragnostic wound platforms. Key innovations covered include: (i) pH-, enzyme-, and thermo-responsive textile drug delivery with quantitative release kinetics; (ii) biomimetic scaffolds (lotus, spider silk, and gecko) replicating native ECM; (iii) e-textiles integrating physical, bio-potential, and biochemical sensors; and (iv) closed-loop theragnostic dressings that autonomously detect infection and trigger drug release. Unlike prior reviews, we systematically address regulatory pathways (FDA and MDR), sustainability (lifecycle analysis), and clinical translation barriers (power autonomy, washability, scalability, and procurement/reimbursement pathways). We conclude that while laboratory prototypes demonstrate extraordinary capabilities, clinical adoption requires standardized testing, scalable manufacturing, and large-scale validation. This review offers materials scientists, bioengineers, and clinicians a roadmap for developing next-generation intelligent textile platforms for predictive, personalized, and regenerative medicine.