Antimicrobial biomaterials in diabetic foot ulcer management: Current Progress and future perspectives

Diabetic foot ulcers (DFUs) represent one of the most debilitating and costly complications of diabetes, with bacterial infection and biofilm formation as primary drivers of wound chronicity and treatment failure. In response, antimicrobial biomaterials have emerged as a transformative strategy that actively modulates the wound microenvironment. This review surveys recent advances in antimicrobial biomaterials for DFU repair over the past five years, focusing on design strategies, mechanisms, and translational potential. We review natural polymers (chitosan, collagen, alginate), synthetic polymers (PLA, PGA, PLGA, PCL), inorganic antimicrobials (metal nanoparticles, bioactive glass), and bioactive molecules (antimicrobial peptides). We highlight integration of broad-spectrum antimicrobial activity, biofilm disruption, inflammation regulation, angiogenesis, and tissue regeneration—within a single platform. We discuss 3D/4D bioprinting, smart responsive systems, lab-on-a-chip/microfluidics, and smart wearables driving personalized, monitorable, and intelligent wound management. Despite preclinical promises, challenges remain in clinical evidence, cost-effectiveness, scalability, and regulatory pathways. Future directions emphasize multidisciplinary collaboration to translate these platforms into practice and improve DFU outcomes worldwide.