Systematic review on chitosan dressings for diabetic and burn wound healing: preclinical outcomes and limitations

This systematic review evaluates the effectiveness and physicochemical properties of chitosan-based wound dressings used to treat diabetic and burn wounds, focusing on how different therapeutic combinations influence healing outcomes. Literature from Scopus, Web of Science, Dimensions, and PubMed was selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The effects of compositional and treatment variables on wound regeneration were analyzed through multivariate (PCA) and bivariate (correlation) statistics. Out of 991 records initially identified, 40 studies met the criteria for inclusion in this review, with a subset evaluated via a meta-analysis. These studies were assessed for their methodological quality and risk of bias using tools such as SYRCLE and MINORS. The results highlighted high variability in the treatment outcomes, with wound regeneration influenced by factors such as tensile strength, drug release profiles, and biocompatibility characteristics. The chitosan-based dressings demonstrated significant potential to enhance wound healing and were generally effective in promoting regeneration compared to that under no treatment or the use of standard gauze. The meta-analysis indicated that while chitosan dressings provide beneficial effects, treatment optimization still faces challenges related to the material composition and variability in the application methods. In conclusion, this review emphasizes the global importance of chitosan-based wound dressings in improving the outcomes for patients with complex wounds.