Bacterial Cellulose Scaffolds for Advanced Wound Care: Immunomodulation, Mixed Biofilms, and Smart Regenerative Dressings

Bacterial cellulose (BC) has emerged as a structurally robust, biologically compatible, and highly adaptable biomaterial with significant potential for next-generation wound-care technologies. Its nanofibrillar, extracellular-matrix-like architecture provides exceptional moisture retention, mechanical stability, and conformability, enabling BC to function as an active scaffold rather than a traditional dressing. Advances in chemical modification, composite engineering, and bioactive functionalization, including antimicrobial metals, chitosan, biosurfactants, enzymes, and growth factors, have expanded BC’s therapeutic capabilities. Emerging smart BC dressings integrate biosensors, stimuli-responsive drug release, and 3D-printed architectures tailored to patient-specific wound geometries. Parallel developments in artificial intelligence (AI) are transforming BC production by optimizing bioprocessing, guiding genetic engineering, reducing culture media costs, and enabling real-time quality control, thereby improving scalability and industrial feasibility. These combined innovations position BC as a multifunctional, immunologically instructive, and digitally integrated platform for advanced regenerative wound care. This review reframes BC within the contemporary pathophysiology of chronic wounds, emphasizing its roles in immunomodulation, macrophage polarization, angiogenesis, mechanotransduction, and the disruption of mixed bacterial–fungal biofilms that characterize diabetic foot ulcers and other non-healing wounds. BC hydrogels typically contain >90–99% water and exhibit tensile strengths exceeding 200 MPa, enabling robust mechanical performance in wound environments. Advances in BC composites have demonstrated antimicrobial reductions of 3–5 log units against common chronic-wound pathogens.