Adaptive design strategies for irregular cutaneous wound repair: Bridging morphological fit and functional...

Complex cutaneous wound defects, particularly irregular wounds located in dynamic areas such as joints, pose significant challenges to clinical repair due to their intricate geometries and mechanically active environments. Conventional preformed dressings or scaffolds often fail to achieve close conformability, leading to dead space formation, bacterial infection, and impaired healing. In response to these limitations, a range of biomaterials with adaptive characteristics has recently emerged, with the core design concept of enabling materials to actively or passively adapt to the dynamic microenvironment of irregular wounds. This review systematically examines the three fundamental requirements for materials used in irregular dynamic wound repair: geometric conformability for complex cavity filling, mechanical compliance under dynamic stress, and stable tissue-material interfacial integration. It then highlights recent advances in material design addressing these requirements, including shape-adaptive strategies utilizing injectable in situ gelation for precise morphological matching, designs incorporating self-healing networks or toughness dissipation mechanisms to achieve dynamic mechanical responsiveness, and interfacial regulation strategies based on biomimetic adhesion or dynamic covalent chemistry for robust tissue anchoring. Furthermore, the synergistic integration of these adaptive platforms with therapeutic functions such as antibacterial and pro-regenerative activities is explored, aiming to construct multifunctional repair systems that combine morphological adaptation with therapeutic intervention. Discussing the current challenges and future development directions in this field, it provides reference directions for the rational design of advanced materials for complex cutaneous wound repair.