MXene-based multifunctional wound dressings for diabetic wound healing: mechanisms, smart sensing, material...

Diabetic wounds continue to present a clinical challenge in that the persistent inflammatory state, oxidative stress, hyperglycemia, impaired angiogenesis, infection, and defective ECM remodelling all contribute to delayed tissue repair. The purpose of this review is to critically assess recent research on MXene-based multifunctional wound-dressing materials employed for diabetic wound management and their therapeutic mechanisms, smart sensing, drug delivery, material integration, safety, preclinical evaluations, and translation challenges. The high surface area, surface chemistry control ability, electrical conductivity, photothermal response, and ability of MXenes to adhere with polymeric biomaterials have generated a great attraction. Recent advancements in hydrogels, patches, microneedles, smart bandages, drug delivery platforms, and biosensing platforms are reviewed, focusing on redox regulation, immunomodulation, angiogenesis, antibacterial activity, ECM remodelling, controlled drug release, and real-time wound monitoring. The impact of MXene loading, structural properties, terminations, and composite structure on the dressing performance is also discussed. Biological performance in terms of long-term biocompatibility, degradation and clearance, sterilization, storage stability, and preclinical models are evaluated. Even though promising results are apparent in preclinical studies, evidence on short- and long-term safety, functional vascular perfusion, standardized criteria of efficacy, large animal validation, and clinical superiority compared to established wound-care approaches is scarce. Reproducible manufacturing, clinically relevant models, standardized evaluation, well-designed clinical trials, and rigorous safety assessment should be priorities for future studies to advance translation to patients with diabetic wound disease.