Synergistic pathological mechanisms and multifunctional dressing strategies for seawater-immersed wounds

Seawater-immersed (SWI) wounds are characterized by the synergistic effects of hypothermia, hyperosmotic stress, the alkaline and ion-rich seawater microenvironment, and marine Vibrio infections, which collectively impair wound healing and elevate the risk of complications. Conventional dressings are poorly suited for harsh marine environments because they cannot simultaneously offer antibacterial activity, regulate the wound microenvironment, and support tissue repair. This review outlines the core pathological mechanisms of SWI wounds and surveys recent advances in multifunctional dressings, with particular emphasis on hydrogel-based systems, which dominate the current literature alongside other emerging formats including nanofibrous scaffolds, foam dressings, and porous sponges. Key design strategies are then examined, including mechanical strength, wet adhesion, thermal responsiveness, antibacterial activity, intelligent stimulus-responsiveness, and multifunctional integration. Emerging strategies, such as targeted anti-Vibrio therapies and data-driven material design, are also discussed. Together, the insights synthesized here offer a framework for the rational design of advanced SWI wound dressings and practical guidance for their clinical translation in marine wound management.