Hydrogel-Based Platforms for Wound Care: Integrated Strategies for Antimicrobial Delivery and Biofilm Management

Chronic wounds, diabetic foot ulcers, venous leg ulcers, and pressure injuries affect millions of patients worldwide and cost healthcare systems in the order of 150 billion annually, yet treatment options have changed less than the scale of the problem would suggest. Biofilm formation, documented in up to 78% of chronic wounds, is a central cause: bacteria embedded in extracellular polymeric matrices tolerate antimicrobial concentrations up to 1000-fold higher than planktonic cells and sustain a chronic inflammatory state that actively prevents tissue repair. Hydrogels, crosslinked polymer networks with high water content and tunable physicochemical properties, have been widely studied as platforms for addressing these challenges, though the distance between laboratory results and clinical practice remains considerable. While recent reviews have summarized hydrogel materials or antimicrobial strategies in isolation, this review takes a different approach: we treat infection, biofilm persistence, and impaired regeneration as interconnected processes that must be addressed simultaneously, and we examine biofilm management as a distinct therapeutic target rather than merely a subset of antimicrobial delivery. We analyze hydrogel-based wound care across three integrated domains: design principles (natural, synthetic, and hybrid polymer systems; crosslinking strategies; and stimuli-responsive architectures), antimicrobial delivery (silver, antibiotics, antimicrobial peptides, natural agents, and controlled-release systems), and biofilm management (nanoparticle-mediated disruption, enzymatic EPS degradation, photodynamic approaches, quorum-sensing inhibition, and anti-adhesive surface engineering). For each area, we critically evaluate what the preclinical evidence supports, where it falls short, and what would be needed to bridge the gap to clinical application. Translation remains uneven. Among the many FDA- and EMA-cleared hydrogel dressings currently in clinical use, most are simple moisture-retaining or silver-containing formulations, while the multifunctional systems that dominate the research literature are at earlier stages of development. We discuss the main translational priorities, including more predictive preclinical models, long-term nanomaterial safety, harmonized outcome reporting, manufacturing scalability, and health economic evidence, as areas where further work can meaningfully accelerate clinical adoption.