Microneedles for Chronic Refractory Wounds: A Review of Dynamic Regulation Strategies and Therapeutic Applications.

Chronic refractory wounds (CRWs), characterized by delayed healing due to disrupted phases of hemostasis, inflammation, proliferation, and remodeling, pose significant clinical challenges with diverse etiologies such as diabetic ulcers and radiation-induced ulcers. Traditional therapies like debridement and skin flap transplantation face limitations. Microneedle technology has emerged as a promising approach, enabling painless transdermal drug delivery to the dermis while enhancing bioavailability and enabling microenvironment-responsive interventions. In this context, this review highlights advancements in microneedle design, emphasizing material selection and structural innovations tailored for CRW management, and systematically elucidates the mechanisms of action and applications of microneedles for phased regulation of CRW healing in response to the pathologic characteristics of wounds-hemostatic, inflammation regulation, angiogenesis and remodeling stage-in terms of prevention, intervention, and wound monitoring, thereby providing significant reference value for the design and clinical application of microneedles in chronic refractory wounds.