PVA-based hydrogels for chronic wound healing: a systematic review of mechanical, structural, chemical, and biological performance

Polyvinyl alcohol (PVA)-based hydrogels are promising chronic wound dressings owing to their tunable structure, biocompatibility, and capacity to carry bioactive agents. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline, this review synthesised evidence on their mechanical, morphological, chemical, and biological performance from Scopus, PubMed, and Web of Science. From 390 records, 24 articles met the eligibility criteria: original research published between 2022 and 2024 on PVA-based hydrogels for chronic wound healing, reporting quantitative characterisation with in vitro and/or in vivo evaluation; reviews and non-PVA systems were excluded. Thirteen included in vivo and in vitro experiments. Multi-crosslinked hydrogels (chemical-physical and photo-assisted) showed higher tensile strength than single-network formulations, although whether that gain came at the cost of extensibility was crosslinker-specific; optimised porosity supported sustained drug release and cellular infiltration. Incorporated bioactive and electroconductive agents, rather than the PVA matrix itself, drove antibacterial efficacy (up to 98% inhibition of Staphylococcus aureus and 95% of Escherichia coli), antioxidant activity, and angiogenesis. In vivo studies recorded accelerated wound closure, reduced inflammation, and improved collagen deposition and vascularisation. These structure-function-healing correlations indicate notable preclinical potential for multifunctional smart dressings, although standardised evaluation, scalable fabrication, and clinical validation remain necessary for translation.