# Advances in Three Dimensional Bioprinting for Wound Healing: A Comprehensive Review
## 7 Conclusions and Future Directions  
Wound healing is a complex process that depends on the synergistic interplay of many factors and intricate signaling pathways. Recently, hydrogel-based wound dressings have emerged as promising candidates, providing the following benefits: establishing a proper environment for wound healing and expediting the healing process. The ability to fabricate intricate constructs incorporating living cells, therapeutic agents, and customized hydrogels enables bioprinting to fit perfectly into patient-specific needs. As a result of recent improvements in hydrogel-based dressings and the maturation of 3D bioprinting procedures, several studies have demonstrated that these innovations can be utilized to enhance wound closure, re-epithelialization, and angiogenesis, while avoiding cytotoxicity concerns.  
Recent advances in 3D printing technology have concentrated on developing customized 3D printer configurations that are meticulously calibrated to meet the unique needs of individual patients. As a result of these technological advances, a variety of innovative approaches have been developed, including sophisticated scanning systems, robotic mechanisms integrated into 3D bioprinting applications, the seamless integration of artificial intelligence paradigms, and the pioneering application of bioinks for in situ bioprinting, leading to accelerated wound healing processes. Bioprinting technologies possessing four, five, and six axes of motion point towards the possibility of the facile fabrication of intricate 3D structures, necessitating nuanced treatment options for wounds with a wide range of depths. The following factors must be addressed in order for 3D-bioprinted dressings to become practical in clinical settings in the near future:  
1. During the 3D bioprinter design process, the priority should be to reduce the size of the device without compromising advanced features such as creating complex tissue architectures with cellular precision, so that an acceptable wound dressing can be developed and translated into a patient-friendly form;
2. The role of specialists should be limited to controlling 3D printing parameters. Using artificial intelligence to regulate 3D bioprinting parameters would be a significant step towards precision and high-quality dressing production;
3. It is difficult to develop personalized therapies in this field of research due to a lack of tissue availability, a high morbidity rate at harvest sites, as well as the extremely time-consuming extraction and culturing processes. Researchers have recently conducted studies on the design of bioreactors for the mass production of skin tissue components and their integration with 3D bioprinters, which may enable the production of 3D-bioprinted dressings with patient-specific bioinks in the future;
4. In situ bioprinting plays an essential role in shaping 3D bioprinting's future within this broader context. A new technology, in situ bioprinting, involves the direct placement of viable cells and biomaterials onto wound sites, which facilitates the recovery of wounds even after severe injuries.  
The future holds great promise, with wound healing, hydrogel dressings, and 3D bioprinting converging to redefine wound care paradigms, resulting in personalized, effective, and efficient wound care.  
Conceptualization, E.B. ([PERSON]) G.K.-C. and B.A; writing--original draft preparation, E.B. ([PERSON]), S.B.B., F.A. and E.U.; writing--review and editing, E.B. ([PERSON]), G.K.-C. and B.A.; visualization, E.B. ([PERSON]) and G.K.-C.; supervision, E.B. ([PERSON]), G.K.-C. and B.A. All authors have read and agreed to the published version of the manuscript.  
[PERSON] acknowledges the funding from the Scientific and Technological Research Council of Turkey (2219-1059B192100591).  
Not applicable.  
The authors declare no conflict of interest.