Tissue vascularization continues to be a significant and unresolved challenge in in vitro tissue engineering. A promising approach involves binding vascular endothelial growth factor (VEGF) to engineered hydrogels, which stimulates endothelial cells (ECs) to form functional blood vessels. VEGF plays a central role in vascular development from embryogenesis to adulthood by promoting new blood vessel formation and regulating EC proliferation, migration, survival, differentiation, and vascular remodeling. However, vascularization outcomes depend not only on the presence of VEGF but also on its retention, release, and temporal availability to ECs, relationships that remain insufficiently clarified in current VEGF-bound hydrogel studies. Here, we provide a systematic overview of VEGF-bound hydrogels for tissue vascularization, covering major VEGF family members, VEGF-binding strategies within hydrogels, and representative tissue-engineering applications. In particular, VEGF-bound hydrogels are discussed according to the binding strength, including weakly bound, moderately bound, strongly bound, and dynamic or stimulus-responsive systems. We further summarize their applications in cardiovascular tissue engineering, bone regeneration, wound healing, neural repair, and engineered vascular network models. Collectively, this review highlights recent advances in VEGF-bound hydrogels and provides insights for future improvements in constructing physiological models for clinical translation.

Diabetic chronic wounds which often lead to amputation remain a significant unresolved challenge in clinical practice, posing serious risks to patient health and survival. Existing clinical treatments such as topical administration, traditional dressings and debridement are often inadequate to address the complex pathological microenvironment (chronic inflammation, oxidative stress, etc.) of diabetic chronic wounds, resulting in long treatment cycles and poor outcomes for patients. To address the key pathological factors that impede wound healing, a functional hydrogel dressing was developed in this study using natural polyphenol tannic acid (TA) and biocompatible polyvinyl alcohol (PVA), and aldehyde phenylboronic acid (FPBA) and cyanophenylboronic acid (CPBA) as small molecule crosslinkers. The polyphenol-based hydrogel exhibited strong tissue adhesion, ensuring stable adherence to the wound site after application, thereby preventing infection and mechanical re-injury. And the G-PT hydrogel loaded with TA markedly reduced reactive oxygen species (ROS) production and effectively inhibited DNA damage. Meanwhile, they reduced the levels of early inflammatory factors IL-1β, IL-6 and TNF-α, promoted the polarization of macrophages toward an anti-inflammatory phenotype. In vitro and in vivo evaluations demonstrated that the hydrogel significantly promoted the healing of both acute skin incisions and chronic diabetic wounds by mitigating oxidative stress and regulating macrophage polarization. These findings highlight the therapeutic potential of this multifunctional hydrogel dressing as a promising strategy for treating diabetic wounds.

A novel strategy employing one-step engineered dissolvable microneedle patches incorporating hyaluronic acid and bFGF for accelerated wound healing is reported, enabling targeted drug delivery to enhance cell proliferation and collagen deposition. In vivo results demonstrate reduced inflammation, promoted vascular regeneration, and significantly accelerated healing, offering a cost-effective therapeutic strategy.

The healing of diabetic wounds is often impeded by severe bacterial infections, persistent inflammation, excessive accumulation of reactive oxygen species (ROS), and abnormal matrix degradation. Although conventional free silver nanoparticles (AgNPs) possess broad-spectrum antimicrobial activity, their inherent tendency to aggregate and inactivate, as well as its high cytotoxicity limits their clinical application. Moreover, a single bactericidal strategy is insufficient to completely reverse the complex pathogenic microenvironment of the wound. To address these challenges, this study developed a dual-polyphenol biomimetic extracellular matrix (ECM) composite hydrogel with matrix metalloproteinase-9 (MMP-9) and pH-responsive properties, aimed at achieving spatiotemporal precision intervention and active microenvironment remodeling in diabetic wounds. This system employs caffeic acid-modified gelatin and dopamine-modified sodium alginate as a dynamically cross-linked scaffold, incorporated with AgNPs-anchored zinc-aluminum layered double hydroxide (ZnAl-LDH@Ag), that can precisely match the dynamic pathological evolution of the wound. The hydrogel exhibits pathology-adaptive behavior through two complementary mechanisms: gradual MMP-9-mediated remodeling of the gelatin network and infection-associated pH-responsive ion release. MMP-9-mediated degradation enables sustained exposure of ZnAl-LDH@Ag and prolonged matrix remodeling, whereas the acidic microenvironment promotes on-demand release of antibacterial Ag+ and regenerative Zn2+ ions. Additionally, polyphenol moieties provide antioxidant and anti-inflammatory regulation during wound healing. By integrating two-dimensional inorganic layered materials (ZnAl-LDH) with conventional metal nanocrystals (AgNPs), this strategy resolves the clinical paradox in silver-based therapies: the difficulty of balancing high bactericidal activity with low cytotoxicity. In summary, this pathology-driven therapeutic platform enables multimodal synergistic therapy for antioxidant protection, infection control, and tissue regeneration, providing a theoretical foundation and design perspectives for the development of advanced dressings for complex chronic wounds.

As a typical chronic complication of diabetes, the management of diabetic foot ulcers has long faced multiple challenges, including the highly subjective nature of wound assessment, patients'limited capacity for self-care at home, and the difficulty in predicting healing outcomes. The emergence of artificial intelligence (AI) technology offers new approaches to addressing these challenges. Based on recent domestic and international literature, this paper systematically reviews the research progress of artificial intelligence in the care of diabetic foot ulcers, focusing on four key dimensions: intelligent wound assessment (eg deep learning-based image analysis models achieving an F1 score of 93.1% for infection identification and 92.8% accuracy for area assessment), patient self-health management (eg mobile health applications and wearable monitoring devices), the development and application of smart dressings (eg responsive biomaterials and sensor integration), and the prediction of healing trends (eg machine learning prediction models, with support vector machines achieving 85.3% accuracy and an AUC of 0.922 in predicting complete DFU healing). It summarizes key technological achievements and the current status of clinical translation, provides an in-depth analysis of existing shortcomings (including insufficient algorithm generalizability, lack of prospective clinical validation, and absence of data standardization), and outlines future development directions (encompassing multimodal integration, explainable artificial intelligence, and implementation science research), with the aim of offering guidance for the further application of artificial intelligence technology in the field of chronic wound care.

Necrotizing infections of the diabetic foot associated with peripheral vasculopathy remain a critical challenge in emergency and general surgical practice, particularly in low-resource, second-level rural hospitals that lack access to reconstructive subspecialties. We report the case of a 57-year-old man with type 2 diabetes mellitus and peripheral vascular disease who presented to a rural, second-level public hospital in Linares, Nuevo León, Mexico, with a deep, contaminated surgical wound following a prior amputation of the second and third toes of the left foot performed at another rural facility. On admission, he had poor glycemic control, local pain, and a wound bed with abundant slough, debris, fibrin, and liquefactive necrosis threatening progression toward the lateral metatarsals. Management consisted of titrated insulin therapy, broad-spectrum systemic antimicrobials (imipenem and vancomycin), and formal surgical debridement with mechanical washout using saline and iodine solution. Postoperatively, topical dextranomer microbeads (Debrisan) were applied serially to the wound bed to promote continuous autolytic debridement. Dextranomer controlled exudate and mechanically removed fibrin by capillary action without impairing angiogenesis, halting necrotic progression and accelerating the transition to a clean, flat wound bed with highly viable granulation tissue. Guided healing and biological retraction ultimately produced a functional interdigital pincer deformity that preserved plantar weight-bearing, avoiding a major proximal amputation after an 18-day hospital stay. This case illustrates that dextranomer is a low-cost, high-utility adjunct to aggressive surgical debridement for complex, infected diabetic foot wounds in resource-limited rural settings, and that a functional pincer-type anatomical outcome can preserve independent ambulation while avoiding infracondylar amputation.

In this study, a star-chained near-infrared responsive upconversion nanoparticle (UCNP)/Fe-TCPP nanocomposite (UFT) was fabricated via a two-step solvothermal method. Its phase, morphology, and structure were characterized using X-ray diffraction (XRD), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), and fourier transform infrared spectroscopy (FT-IR). Owing to electrostatic matching, UFT selectively targeted and killed Staphylococcus aureus. Under 980 nm irradiation at 1.0 W/cm2, 200 µg/mL UFT achieved a 98.46% bactericidal rate against 1 × 106 CFU/mL S. aureus within 18 min via a synergistic photodynamic/chemodynamic effect. In vivo wound healing experiments showed UFT promoted epidermal regeneration and accelerated wound repair. Radical trapping experiments coupled with electron spin resonance (ESR) spectroscopy identified superoxide anions (•O2-) and hydroxyl radicals (•OH) as the main reactive oxygen species involved in the process. These findings demonstrate that the as-prepared UFT nanocomposite exhibits both excellent near-infrared-responsive antibacterial performance and wound-healing efficacy, providing a promising experimental basis and theoretical foundation for the development of efficient photoresponsive antibacterial materials for the treatment of wounds infected with Gram-positive bacteria.

The COVID-19 pandemic left a lasting imprint on orthopedic surgery, initially through widespread reductions in care delivery and subsequently through the complex challenges posed by Long COVID syndrome. Emerging literature describes Long COVID-related alterations in bone mineral density, delayed wound healing, prolonged inflammation, persistent chronic pain, and increased perioperative risks. Long COVID may adversely affect skeletal integrity through inflammatory, hypoxic, and angiotensin-converting enzyme 2-mediated pathways, potentially leading to bone loss and increased fracture susceptibility. Persistent inflammation, endothelial dysfunction, thrombotic tendency, and neurocognitive impairment may also increase perioperative vulnerability, while chronic musculoskeletal pain, reduced exercise capacity, and post-exertional malaise may complicate rehabilitation and functional recovery. Although orthopedic-specific evidence remains limited, the available findings suggest that Long COVID may represent an underrecognized risk modifier relevant to surgical planning and postoperative management. Greater awareness of these mechanisms may improve patient counseling, risk stratification, and rehabilitation strategies.

Surgical site infection (SSI) after spinal instrumentation surgery remains a challenging complication, particularly in patients with a history of radiotherapy. Radiation-associated skin and soft tissue injuries cause long-lasting impairment of vascularity and regenerative capacity, significantly compromising wound healing and infection control. When SSI occurs in radiation-affected tissue, wound closure becomes difficult, requiring complex reconstructive surgery. A 73-year-old man who had previously received radiotherapy to the lumbar region for malignant lymphoma at the age of 37 (in 1989) developed a late-onset lumbar SSI seven years after posterior lumbar interbody fusion at L3/4. Initial surgical debridement followed by primary wound closure failed, leading to wound dehiscence two weeks postoperatively. Considering the impaired biological regenerative activity of the irradiated tissues, repeated primary closure was avoided. Instead, staged management consisting of extensive debridement, negative pressure wound therapy (NPWT) with continuous local irrigation, and definitive reconstruction using a reverse latissimus dorsi musculocutaneous flap was performed. Although flap coverage was insufficient for the lower lumbar to sacral region, continued NPWT promoted tissue granulation, allowing successful split-thickness skin grafting. Complete wound closure was ultimately achieved. SSI in irradiated tissue may reflect impaired regenerative capacity in addition to the infectious process itself. A reverse latissimus dorsi musculocutaneous flap combined with NPWT and skin grafting enabled successful closure of a large tissue defect of the lumbar spine without infection recurrence at six-month follow-up.