Preparation of bacterial cellulose-based antimicrobial materials and their applications in wound dressing: A review

Wound healing is a complex and dynamic physiological process influenced by various uncertain factors. Despite significant advancements in the development of medical dressings in recent years, challenges remain in addressing infections and delayed healing associated with complex wounds. Due to its ideal properties for enhancing wound healing and tissue regeneration, bacterial cellulose (BC) has garnered extensive attention in biomedical research. On the one hand, the ultra-fine 3D nanofiber network, high water retention capacity, and biocompatibility of BC enable it to absorb wound exudates effectively and provide a moist environment conducive to wound healing. On the other hand, BC can be endowed with excellent antimicrobial properties through physical or chemical modifications, demonstrating immense potential in the field of wound dressing applications. In this review, we integrate molecular mechanisms of wound healing with the biosynthesis and structural characteristics of BC to systematically examine recent advances in the development and characterization of BC-based antibacterial composite materials. These include incorporation strategies involving antibiotics, inorganic nanoparticles, organic antibacterial polymers, cationic antimicrobial agents, and antimicrobial peptides. Furthermore, we conduct an in-depth analysis of the antibacterial mechanisms underlying BC composites modified with distinct antimicrobial compounds, along with their direct impacts on wound healing processes, aiming to provide nuanced insights and technical recommendations. Finally, we address current challenges in BC-based medical dressings and explore future development trajectories for BC-derived wound healing materials from perspectives of manufacturing technologies and commercial applications.