Smart materials for wound care: from passive dressings to autonomous bioelectronic systems

Background Chronic and infected wounds remain a major clinical challenge because of persistent inflammation, hypoxia, microbial biofilms, and dysregulated wound microenvironments. Conventional dressings provide passive protection but cannot monitor pathological changes or deliver targeted therapy. Smart wound dressings (SWDs), including stimuli-responsive hydrogels, bioelectronic interfaces, wearable sensors, and closed-loop systems, have emerged as multifunctional platforms capable of real-time monitoring and therapeutic intervention. Although preclinical studies consistently demonstrate antimicrobial efficacy, microenvironment regulation, and accelerated healing, particularly in diabetic and infected wounds, clinical translation remains limited. Objective To determine whether SWDs integrating sensing, biosignal interpretation, or responsive therapeutic functions improve wound healing, infection control, microenvironment regulation, or diagnostic accuracy compared with conventional passive dressings in preclinical and clinical wound models. Methods A structured literature search of PubMed, Web of Science, and Scopus identified studies published between January 2018 and June 2026 following PRISMA 2020 guidelines. Eligible studies evaluated integrated sensing, wound microenvironment monitoring, stimuli-responsive therapy, bioelectronic actuation, or closed-loop control. Data on sensing modalities, biomarkers, therapeutic mechanisms, healing outcomes, antimicrobial performance, and engineering characteristics were extracted. Owing to substantial heterogeneity in materials, sensing technologies, biomarkers, and outcome measures, findings were synthesized narratively. Study quality was assessed qualitatively, and certainty of evidence was evaluated using a GRADE-informed approach. Results Of 2143 records screened, 312 studies met the inclusion criteria (298 preclinical and 14 clinical). Because many eligible studies reported overlapping technologies and outcomes, only 128 representative studies were cited to provide a concise synthesis of the evidence. Preclinical studies consistently demonstrated enhanced antimicrobial activity, regulation of pH, reactive oxygen species, oxygenation, and moisture, and accelerated healing in diabetic and infected wound models. Stimuli-responsive hydrogels enabled controlled therapeutic release, while nanozyme-enhanced systems improved oxygenation and reduced inflammation. Wearable, microfluidic, and bioelectronic platforms enabled continuous biomarker monitoring, electrical stimulation, and closed-loop therapeutic intervention, with machine learning improving wound classification and prediction of complications. Across representative studies, SWDs improved wound closure by 20–65%, reduced bacterial burden by 1–4 log units, and outperformed conventional dressings in regulating the wound microenvironment. However, clinical evidence is limited to small feasibility studies, and no controlled trials have demonstrated that continuous monitoring or closed-loop therapy independently improves healing outcomes. Limitations Evidence is dominated by heterogeneous preclinical studies, limiting quantitative meta-analysis. Sensor stability, calibration, biofouling, mechanical durability, and regulatory approval remain major barriers to clinical translation. In addition, standardized biomarker thresholds, clinical workflow integration, and long-term usability have not been established. The review was not prospectively registered, non-English studies were excluded, and publication bias may have influenced the findings.