The authors highlight that adult human wound healing typically prioritises rapid closure over tissue restoration, resulting in scar formation, collagen disorganisation and loss of structures such as hair follicles and sebaceous glands. In contrast, fetal wound healing demonstrates the ability to regenerate skin with minimal fibrosis and more normal tissue architecture. 

The review explores how researchers are attempting to recreate these regenerative healing environments through approaches including stem-cell-derived exosomes, secretome therapies, immunomodulation, bioactive hydrogels, growth factor delivery systems and 3D bioprinting technologies. 

Particular emphasis is placed on the role of inflammatory signalling, macrophage behaviour and mechanotransduction in determining whether tissue undergoes fibrosis or regeneration following injury. According to the authors, excessive mechanical tension and dysregulated immune responses appear to be major drivers of scar formation. 

The paper also notes that many current anti-scarring interventions target fibrosis after it has already developed, whereas newer regenerative approaches aim to influence healing much earlier in the repair cascade. 

The authors conclude that scarless wound healing remains a major challenge in regenerative medicine, but suggest that advances in biomaterials, immune modulation and bioengineering may help support more regenerative tissue repair in the future.