Advances in hemostatic sponges: from materials and biofabrication strategies to biomedical applications

Hemorrhage remains one of the leading causes of trauma-related mortality worldwide and poses a major challenge in surgery, emergency medicine, and battlefield rescue. Conventional hemostatic materials, such as gauze and gelatin sponges, mainly rely on passive blood absorption and compression, which often exhibit limited efficacy in irregular wounds and severe bleeding environments. In recent years, advances in biomaterials and tissue engineering have promoted the development of hemostatic sponges with enhanced absorption capacity, bioactivity, tissue adhesion, antibacterial performance, and wound healing ability. Compared with other hemostatic platforms, sponge-based systems offer unique advantages derived from their interconnected porous architectures, enabling rapid blood transport, coagulation component enrichment, mechanical wound filling, and structural adaptation in complex bleeding scenarios. In this review, we discuss the development of hemostatic sponges from the integrated perspectives of material systems, biofabrication strategies, structural regulation, and biomedical applications. Different classes of materials, including polysaccharides, proteins, and synthetic polymers, are systematically discussed with emphasis on their intrinsic hemostatic mechanisms, functional modifications, and design limitations. The relationship between sponge structures and hemostatic performance, including pore architecture, interconnected channels, shape-memory behavior, and surface functionality, is highlighted. Representative fabrication strategies and multifunctional applications, including antibacterial activity, wound healing, and non-compressible hemorrhage control, are summarized. Finally, current challenges and future perspectives regarding intelligent design, standardized evaluation, and clinical translation of next-generation hemostatic sponges are discussed. This review provides design principles and translational insights for developing advanced hemostatic sponge systems.