pH-Responsive Smart Polymers and Nanoparticles in Chronic Wound Care: A Systematic Review of Preclinical Evidence and Implications for Future Nursing Practice

Abstract

Context: Pressure injuries and diabetic foot ulcers remain major challenges in contemporary health care. Chronic wounds are characterized by impaired healing, persistent inflammation, microbial contamination, and alterations in the wound microenvironment, including alkalinization. pH-responsive polymers and nano-enabled components have therefore been investigated as platforms for controlled therapeutic release, antimicrobial activity, and experimental wound monitoring. This review synthesized primary preclinical evidence on pH-responsive polymeric wound systems and polymer–nanoparticle wound systems and considered their relevance to future nursing research and wound-care practice. Evidence Acquisition: A PRISMA 2020-guided search of PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, Embase, the Ovid platform, ProQuest, SID, and Google Scholar covered the period from January 2017 to January 31, 2026. Only primary in vitro and/or in vivo studies that directly evaluated a pH-responsive polymeric wound platform, with or without an integrated nano-enabled component, and reported a therapeutic, antimicrobial, sensing, or wound-repair outcome were eligible. Animal components were assessed using the SYRCLE risk-of-bias tool; in vitro components were assessed using the QUIN tool; and ARRIVE 2.0 Essential 10 was used only to describe the completeness of animal reporting. Studies with low or medium QUIN risk and without a critical SYRCLE concern regarding outcome assessment or selective reporting were retained. Fourteen primary preclinical studies were included. Results: The 14 included studies comprised 10 combined in vitro/in vivo investigations and 4 in vitro-only studies. pH-responsive hydrogels, nanofibers, nanozyme systems, and sensing platforms were associated with controlled release, reduced bacterial burden, oxidative stress modulation, angiogenesis-related responses, wound closure, or experimental pH monitoring. In the appraisal, QUIN scores ranged from 18/24 to 21/24 (75.0%-87.5%; low risk of bias), ARRIVE Essential 10 reporting ranged from 7/10 to 9/10, and the animal-study components were interpreted as having some concerns under the prespecified SYRCLE decision rule, mainly because randomization and blinding were incompletely reported. Conclusions: Current evidence is limited to preclinical and proof-of-concept models. pH-responsive polymeric and nano-enabled wound systems demonstrate promising experimental antimicrobial, regenerative, controlled-release, and sensing functions; however, their clinical effectiveness, safety, usability, cost-effectiveness, and applicability in nursing practice remain unestablished and require confirmation in rigorously designed human studies.