Recent advancements in bioadhesive self-healing hydrogels for effective chronic wound care

The science behind wound healing is based on a highly complex and dynamic multiphase process involving a mesmerizing dance of cells and factors orchestrated by intricate molecular signaling pathways, leading to wound self-repair in our bodies. Any interference in the healing process timeline can result in various complicated wound pathologies, resulting in chronic non-healing wounds (CNHW), including diabetic wounds, venous ulcers, or pressure ulcers. CNHW is a major clinical concern in healthcare systems worldwide, with a prevalence of nearly 2.2 per 1000 people [1]. Due to the growing population of elderlies, chronic diseases such as diabetes and obesity are expected to increase dramatically. Another issue is the increasing antibiotic resistance among bacteria's, something which could create even more havoc in ulcers stemming from diabetes. The global chronic wounds prevalence by continent and the distribution of wound and ulcer types are depicted in Fig. 1a. The continuous release of exudates and free radicals from CNHW creates excessive and persistent inflammation and infection, which is suitable for forming drug-resistant infective biofilms [2]. These impair the body's innate reparative mechanisms and its response to external treatments. Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients. Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention towards managing these perturbations can often lead to successful healing. Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based. Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.