Stimuli-Responsive Smart Bandages for Chronic Wound Management: From Sensing Platforms to AI-Driven Closed-Loop...

Chronic wounds remain a major healthcare challenge because persistent inflammation, biofilm formation, oxidative stress, protease imbalance, hypoxia, and impaired angiogenesis prevent progression through normal healing. Conventional wound dressings provide passive protection but cannot continuously monitor the dynamic wound microenvironment or deliver adaptive therapy. Unlike previous reviews that independently summarize wound biosensors, responsive biomaterials, or drug-delivery systems, this review critically integrates the complete closed-loop paradigm of intelligent wound management, from single- and multi-stimuli-responsive sensing to AI-assisted autonomous therapeutic intervention. Chemical and physical sensing modalities are comparatively evaluated based on analytical performance, selectivity, clinical readiness, and translational limitations, while multi-responsive logic-gated platforms are assessed against conventional single-stimulus systems. The review further synthesizes available human clinical evidence, compares fabrication strategies and manufacturing scalability, and discusses regulatory pathways governing combination products, Software as a Medical Device, and AI-enabled wound care. Particular emphasis is placed on AI model development, data quality, validation, bias mitigation, and cybersecurity requirements for safe clinical deployment. Finally, major barriers including material scalability, long-term biocompatibility, sensor robustness, standardized clinical validation, and regulatory governance are critically analyzed to establish a translational framework for developing clinically reliable, intelligent smart bandages capable of precision management of chronic wounds.