Emerging antimicrobial hydrogel dressings based on bacterial cellulose-chitosan composites: A review

Wounds result from disruptions in the tightly regulated wound healing process, which is often complicated by comorbidities, infections, and biofilm formation. Advancing therapeutic strategies relies on a comprehensive understanding of cellular and molecular mechanisms, with particular emphasis on host-pathogen interactions. Early intervention can prevent biofilm maturation through antioxidant and anti-inflammatory treatments administered within 24 h post-debridement. Furthermore, growth factors can promote angiogenesis and tissue regeneration. The escalating challenge of antibiotic resistance highlights the critical need to develop effective alternative therapies. Antimicrobial hydrogel wound dressings composed of nanomaterials represent a promising strategy that integrates effective infection control with accelerated tissue regeneration. This review focuses on composite materials composed solely of bacterial cellulose and chitosan, which exhibit excellent antibacterial, antibiofilm, and antioxidant activities along with high porosity, superior fluid absorption capacity, and strong support for cell migration. The originality of this work lies in its detailed discussion of the influence of these composites on the molecular mechanisms underlying angiogenesis. Preclinical and clinical studies support their potential in promoting wound healing. Future advancements are likely to involve the development of smart hydrogels incorporating pH- and temperature-responsive sensors and controlled-release systems, leading to more effective and sustainable approaches to wound care.