Smart-responsive chitosan dressings: From microenvironmental sensing to multifunctional precision wound healing

• Chitosan dressings enable intelligent sensing of pH, ROS, and enzyme signals. • Multi-responsive systems achieve controlled drug release and adaptive repair. • Combines antibacterial, angiogenic, and immunomodulatory wound therapies. • Provides translational insight for treating diabetic ulcers and chronic wounds. Wound healing constitutes a multifaceted and dynamically regulated process that is modulated by a variety of microenvironmental factors such as pH, enzymes, and reactive oxygen species (ROS). Conventional wound dressings frequently fail to deliver the precise interventions necessary for the effective management of complex wounds. Chitosan, characterized by its high biocompatibility, biodegradability, and structural adaptability, exhibits enhanced self-healing photoactivity, rendering it an ideal candidate for the development of smart, responsive wound dressings. This review systematically examines the design strategies, molecular mechanisms, and therapeutic applications of chitosan-based smart dressings. It emphasizes their roles in infection control, inflammation reduction, angiogenesis, and tissue regeneration. Furthermore, we underscore the importance of multimodal systems incorporating adaptive feedback mechanisms (pH/ROS combinations, pH/enzyme and ROS/photothermal coupling) and explore their clinical potential in the treatment of diabetic foot ulcers, pressure ulcers, and other complex skin injuries. These findings provide a detailed framework for the development of the next generation of bio-responsive materials, fostering the integration of materials science with personalized wound care strategies.