Probiotic and Postbiotic Delivery Systems for the Management of Chronic Wounds: A Review of Emerging Strategies.

Abstract

Chronic wounds, particularly diabetic foot ulcers (DFUs) and burn wounds (BWs), impact millions of individuals globally and generate substantial healthcare costs, highlighting the urgent need for more effective therapies aimed at controlling infections. Currently, there is growing evidence of beneficial effects of selected bacterial strains, including <i>Lactobacillus plantarum</i>, <i>Lactobacillus reuteri</i>, <i>Lactobacillus rhamnosus</i>, <i>Lactobacillus paracasei</i>, <i>Bifidobacterium longum</i>, and <i>Escherichia coli</i>, as well as fungi from the genus <i>Saccharomyces</i> spp. Each of these species exerts a distinct influence on the wound microenvironment. This review compiles evidence from PubMed-indexed studies published between 2016 and 2026 regarding the application of external dressings and other topically administered formulations containing probiotic or postbiotic preparations in the management of DFUs and BWs. Probiotic strains facilitate wound healing through various mechanisms, including the secretion of antimicrobial metabolites (such as organic acids, hydrogen peroxide, and bacteriocins), inhibition of biofilm formation by pathogens like <i>Staphylococcus aureus</i> and <i>Pseudomonas aeruginosa</i>, immunomodulation, local acidification, and stimulation of growth factors and components of the extracellular matrix. Various methods for delivering microorganisms with probiotic properties are being evaluated. These approaches can be broadly divided into two main categories: probiotic-containing dressings and non-dressing-based methods (i.e., ointments or biohybrid microneedles). It is indicated that postbiotics - metabolic byproducts or structural components of microbial cells - may likewise contribute positively to wound repair. A reduction in pathogen load and positive healing outcomes in DFUs and venous or burn ulcers with <i>L. plantarum</i> dressings is indicated, although evidence sizes are still limited. Current evidence suggests that probiotic-based dressings could serve as a promising adjunctive strategy in the management of chronic wounds; however, further well-designed clinical trials are necessary to validate efficacy, identify optimal strains and carriers, and assess long-term safety. While a large body of in vitro and animal model data exists, robust evidence from randomized controlled trials in humans remains scarce.