Innovative scaffold-based strategies for diabetic wound healing: progress and prospects

Diabetic wounds present a major clinical concern due to chronic inflammation, impaired angiogenesis, excessive protease activity, and delayed extracellular matrix remodelling, leading to prolonged healing and high recurrence rates. Globally, over 536 million individuals were affected by diabetes in 2021, with diabetic foot ulcers impacting approximately 15-25% of these patients during their lifetime. Conventional wound dressings often fail to address the complex pathophysiology of diabetic wounds, necessitating advanced therapeutic strategies. Scaffold-based biomaterials have emerged as promising regenerative platforms by providing a 3-dimensional microenvironment that supports cell adhesion, proliferation, and controlled delivery of bioactive agents. Recent advances in nanofibrous scaffolds, hydrogels, and decellularized extracellular matrices have demonstrated enhanced angiogenesis, reduced inflammation, and accelerated wound closure in preclinical diabetic models, with several systems achieving over 90% wound contraction within a period of 14-21 days. This review critically discusses scaffold design principles, biomaterial selection, and emerging modification strategies, highlighting their translational potential for effective diabetic wound management.