Electrospun Janus Nanofibrous Membranes for Diabetic Foot Ulcers: Structure-Function Relationships and Multifunctional Synergistic Therapy

Diabetic foot ulcers (DFUs) are critical chronic diabetic complications that remain difficult to heal owing to excessive exudation, persistent infection, prolonged inflammation, oxidative stress, and impaired tissue regeneration. Conventional wound dressings often fail to address these interconnected pathological conditions. Electrospun Janus nanofibrous membranes (JNMs) with asymmetric structures offer unique opportunities to spatially regulate the wound microenvironment while integrating multiple therapeutic functions within a single platform. This review summarizes recent advances in electrospun JNMs for DFU treatment from the perspective of structure-function relationships. The fabrication methods and structural design principles of JNMs, including asymmetric wettability, pore structures, interfacial functionalization, and spatial therapeutic distribution are first discussed. The relationships between these structural characteristics and key functional properties, including directional exudate transport, controlled therapeutic delivery, antimicrobial and antibiofilm activity, mechanical adaptability, and microenvironment regulation, are then analyzed. Subsequently, the therapeutic applications of JNMs in DFU management, together with recent developments in stimuli-responsive and bioelectronic systems, are reviewed. Finally, current challenges related to mechanical and structural stability, degradation-regeneration compatibility, scalable manufacturing, biosafety, standardized evaluation, and clinical translation are discussed. By linking DFU-specific pathological requirements with JNM structural design, functional regulation, and therapeutic outcomes, this review provides a framework for the rational development of multifunctional Janus dressings for DFU treatment.