Smart Scaffold Technologies for Diabetic Foot Ulcer Treatment: A Novel Approach to Tissue Regeneration

Diabetic foot ulcers (DFUs) remain a major clinical concern due to chronic inflammation, dysfunctional angiogenesis, and increased susceptibility to infection, often resulting in delayed healing and the potential for limb amputation. Smart scaffold technologies have emerged as sophisticated biomaterial systems that recreate the extracellular matrix, thus providing not only cellular mechanical support, but also controlled drug release and dynamic biological response. Recently, polymer science, electrospinning, bioprinting, and injectable hydrogels have been significantly combined to produce multifunctional scaffolds that can not only support cell growth and vascularization but also provide targeted antimicrobial treatment. However, despite the fact that preclinical studies showed great potential, several issues still puzzle the transition to clinical use, such as mechanical compatibility with native skin, control of drug release kinetics, scaling production processes, regulatory issues, and cost-effectiveness. In this article, various scaffold mechanical properties with respect to native skin, biomaterial choice, manufacturing scalability, regulatory issues, and clinical effectiveness are thoroughly compared and discussed, whereas previous reviews mostly focused on biomaterial composition or fabrication techniques. On top of that, the crucial progress in sensor-embedded and smart scaffolds is pointed out as the future potential of personalized DFU treatment. This review briefly discusses the major issues that need to be addressed for smart scaffold technologies to go from the laboratory to the hospital, at the same time recognizing a translation challenge and technological progress.