The dual role of the microbiome in chronic wound management

Chronic wounds are characterized by delayed healing driven by persistent dysbiosis of the wound microbiome. Distinct microbial communities, often organized as biofilms, dominate different chronic wound types and impair tissue repair through metabolic disruption, immune evasion, and sustained inflammation. Emerging evidence indicates that probiotics can modulate wound-associated microbiota by suppressing pathogenic colonization, reshaping local metabolic and immune responses, and promoting a pro-regenerative microenvironment, both locally and via the gut-skin axis. Recent advances in natural product-derived biomaterials provide new opportunities to enable probiotic-based interventions through controlled delivery and protection of microbial function. This review summarizes the dual role of the microbiome in chronic wound pathology and healing, evaluates the challenges and risks of probiotic therapies, and highlights microbiome-responsive materials as translational tools. We propose that targeted microbiome interventions should evolve through a closed-loop strategy integrating microbiome profiling, strengthened product and technology development, and adaptive clinical management to achieve precision wound care.