Wound healing is a complex physiological response that involves a cascade of cells, matrix components and other biological factors [16]. In healthy people, wound healing includes four important phases: hemostasis, inflammation, proliferation, and remodeling. This complex process allows skin functions to be restored. Wounds that fail the normal healing process in a predictable amount of time are considered chronic wounds (CW) [210,211]. Currently, wound care is based on the application of a wide variety of wound dressings (gauzes, absorbent cotton and bandages), debridement, vacuum assisted closure and grafts. Even though they are considered the therapy of choice, wound dressing have some limitations, they are incapable of maintaining the moist environment necessary for wound healing and tend to adhere to the wound, which may cause discomfort to the patient when the dressing is removed [212]. CW treatments are often associated to high economic costs, an increase in surgical procedures and the greater susceptibility of the patient to infection. Microorganisms such as Acinetobacter baumannii, Enterococcus faecalis, Pseudomonas aeruginosa and Staphylococcus aureus have the ability to colonize and infect wounds, which complicate the healing process [6,210]. In the most severe cases, patients with infected wounds, such as diabetic foot infections, include mainly antibiotics in their therapy [213]. The impact of excess and inappropriate use of antibiotics has been explored in relation to the various adverse effects, such as bacterial resistance, which has been highlighted as a serious global concern [135]. Several alternatives have been developed for a more efficient wound healing in order to prevent infection to evolve and, in the case of CW, to try and shorten the treatment period [212,214,215,216,217]. There are some properties that ideally a modern wound dressing should have, specifically, the capacity for mechanical protection and adaptation to the shape of the wound, without adhering to wound tissue per se, so as not to cause pain to the patient when removed. Absorption capacity, cytocompatibility, flexibility, ability to ensure a balanced moist environment, induce wound healing, facilitate ECM regeneration, protect the wound from external contaminants and promote debridement are also important features in the development of an effective wound dressing [6,33,166,212]. Wound dressings can be classified based on the affinity of the dressing with the wound into four distinct groups: passive, interactive, advanced and smart dressings [211]. Modern dressings take the most varied forms, including hydrogels, films, sponges, foams, nanofiber mats and, more recently, fiber–hydrogel composites [33,206]. The hydrogel has the ability to absorb exudates and maintain a balance of moisture at the wounded site. In turn, the fiber mimics the fibrous structure of ECM. Since both structures present limitations, the fibers do not facilitate cell migration and hydrogels have low mechanical stability, scaffolds combining both have been the research target of many investigations in order to uncover alternatives for the treatment of wounds [206,217,218]. The combination of the two structure in one scaffold is expected to facilitate healing by generating an environment conducive with cell recognition and attachment (ECM mimicking) with a moist and breathable atmosphere required for a healthy tissue formation. It is known that a large part of mammalian ECM has an aqueous matrix (gel) containing diverse fibrous proteins, essentially collagen, elastin and fibronectin. These proteins surround and guide cells in vivo and act as an anchoring matrix [219,220]. In humans, fibrillar collagen provides tensile strength for ECM, which limits tissue/organ distensibility as is the case of the skin [221]. The ECM is mainly responsible for cell adhesion, migration, proliferation, and regulation of their action. For a complete and effective skin regeneration, it is important that a scaffold is created that mimics the structure and normal skin conditions. Studies have shown that the reinforcement of hydrogels with fibers improves cell function, differentiation and proliferation, as well as structural stability [182,183,195]. Indeed, Schulte et al. described the manufacture of an artificial ECM scaffold consisting of biofunctionalized fibers incorporated in a semi-synthetic hydrogel of HA that allowed the control of cell adhesion [220].

There are several polymers used in fiber–hydrogel composites, namely gelatin [206,217,222]. The combination of two separate scaffolds (bilayer scaffold) was studied by Franco et al. for a possible application in skin regeneration. The formulation consisted of a first layer based on a PCL/PLGA membrane (80:20) formed by electrospinning and a second layer of CS/gelatin hydrogel (50:50) crosslinked with glutaraldehyde. The first layer showed excellent mechanical properties and biocompatibility. In the case of the second layer, they obtained a porous structure, capable of swelling more than 500% of its dry size (excellent absorbent properties). The junction of the fibrous membranes provided better mechanical support to the scaffold and, at the same time, reduced the rate of degradation of the layer formed by the hydrogel [222]. In the same light, Zhao et al. through a chemical reaction of the methacrylamide groups with gelatin formed a prepolymer to produce fibers by electrospinning (GelMA). The electrospun GelMA nanofibers were crosslinked by photo-crosslinking, with UV radiation. By manipulating the degree of modification of the gelatin with the methacrylamide groups and the photo-crosslinking time, it is possible to adjust the physical and biological properties. Characteristics such as water vapor permeability, water retention, mechanical resistance and kinetic degradation can be adapted by adjusting the time of UV light radiation. These GelMA scaffolds, which mimic the structure of the native ECM, demonstrated a better orientation of the cellular processes (e.g., cell migration of fibroblasts) and biocompatibility compared to the controls (gelatin and PLGA). The in vivo tests reinforce the potential of this scaffold since it was visible that they accelerated wound repair [217]. Sun et al. went a step further and reported the ability of the GelMA to improve the elastic biodegradable mechanical properties of the construct and its ability to improve cell adhesion, proliferation and vascularization [223]. In turn, Li et al. reports the use of gelatin for the development of a hydrogel fibers. Initially the gelatin-based compound hydrogel fibers were prepared by gel-spinning with PEG6000. Subsequently, the crosslinking agent dialdehyde carboxymethyl cellulose (DCMC) was incorporated in order to improve the thermal and mechanical properties of the hydrogel fibers composed of gelatin-PEG. This scaffold showed a strong capacity to absorb free water due to its 3D structure and porous network. The higher the DCMC content in hydrogel fibers, the more slowly they degrade. In addition, DCMC increased the compatibility of the hydrogel fibers with blood [206]. HA nanofibers are reported to promote wound healing. Due to their high solubility in water, crosslinking is required to increase their water stability. Chen et al. developed an electrospun a mixture of maleicated hyaluronate/poly(vinyl alcohol) methacrylate (MHA/MaPVA) that allowed the formation of mats with the capacity to swell and form fibrous hydrogels. The weight ratio of the nanofiber components influenced the morphology and diameter of the nanofibers. This structure was cytocompatible, promoted cell fixation and displayed high water absorption capacities [218]. PVA has also been combined with PCL to form double layer structures resultant from the combination of PCL nanofibers (hydrophobic) and PVA hydrogel (hydrophilic). After exposure to water, the PVA fiber layer was completely dissolved, and a hydrogel-like structure was formed. Despite this change, the defined shape of the scaffold was maintained due to the stability of the PCL layer in water-based environments. Several aspects were tested in this scaffold, namely, its morphology, wettability, and adhesion and proliferation of mouse fibroblasts. Here, it was seen that fibroblasts exhibited greater proliferative activity on the PCL side of the double layer. In the case of the PVA layer, the same was not seen, which may be a consequence of the greater hydrophilicity of the layer. Based on the behavior and characteristics of the double layer scaffold, the authors concluded that the scaffold had the potential to be used as a dressing or in the prevention of abdominal adhesions [194].

The rapid dissolution of fibers in an aqueous medium becomes a limitation for their application in active wound dressings. In the case of PVP fibers, their rapid solubility remains a problem despite their self-adhesive properties and their ability to incorporate molecules. Recently, to overcome this limitation Contardi et al. proposed to develop PVP-based fiber hydrogels containing hydroxycinnamic acid derivatives. A controlled release of p-cumaric and ferulic acids (derived from hydroxycinnamic acid) from the fibers was observed due to the incorporation of these in the hydrogel. The author also observed in burned skin a reduction in the levels of enzymes known to be positively regulated by reactive oxidative species in burned skin [224]. By electrospinning/electrospraying methods, Azarniya et al. reported the production of a hybrid fiber–hydrogel by combining fibrous mats and hydrogel particles. Through electrospinning, keratin/bacterial cellulose (BC) fibers were produced and simultaneously sprayed with thermosensitive hydrogel particles. The chemically crosslinked hydrogel was composed of non-ionic triblock copolymers (PEO99-PPO65-PEO99; Pluronic F127) conjugated with Tragacanto gum (TG). Due to the low spinning power of keratin, poly(oxide of ethylene) (PEO) was added to the formulation forming the keratin/BC/PEO fibers. Reductions in the diameter of keratin/PEO fibers from 243 ± 57 nm to 150 ± 43 nm and hydrophobicity were observed with the addition of 1% or more of BC. However, despite the reduction of pores, TG and BC modified mats promoted cell fixation and proliferation in fibrous structures. It was seen that the hydrogel particles were uniformly incorporated into the junction of the fibrous network. This modification improved several features of the scaffolds, including hydrophilicity, modulus of elasticity (31%), tensile strength (35%) and ductility (23%) [225]. More recently, Loo et al. developed “intelligent” peptide hydrogels, in which the short aliphatic peptides had the tendency to self-assemble into helical fibers, forming nanofiber hydrogels. These nanofibrous hydrogels were found to possess regenerative properties and to display potential to accelerate the healing of burn wounds [226].

In conventional therapies, rapid degradation and excretion of drugs during the circulation process in the body is frequently detected. Consequently, only a small amount of medication will have therapeutic effects in places of interest [227]. Several research groups have focused on the development of new controlled drug delivery systems to allow an effective distribution of drugs in the intended locations at a controlled release rate [193,228]. A drug delivery system is used to transport therapeutic substances in the body more effectively and safely, having the ability to control the amount, the time and the targeted place for drug release [229]. Several scaffolds have been used to encapsulate and deliver therapeutic drugs, namely, fibers and hydrogels [102,230,231,232].

Electrospinning systems allow drugs to be incorporated into the fibers, giving them a high drug loading capacity, increased initial burst, sustained release, and prolonged circulation. Methods of incorporation include blend (or co-, the drug is mixed in the polymer solution), side-by-side (vehicle/polymer solution and the biomolecules are loaded in a separate spinneret), multi-jet (use of multiple nozzles with one or more jets, or a nozzle with different jets), co-axial (two concentric aligned capillaries connected to a high voltage source) and emulsion electrospinning (the drug is encapsulated in an appropriate solvent to be protected from the fiber/solvent system) [48]. Just as there are different ways to incorporate drugs into fibers, drugs may also be released via three distinct mechanisms: desorption of the fiber surface, diffusion in the solid state through the fibers, and fiber degradation [233]. The fiber morphology and its high therapeutic load capacity are beneficial properties that make them potential candidates for drug delivery systems. Electrospun fibers have several advantages especially due to their large surface area and their absorption/release properties [234]. However, large-burst drug release, uncontrolled duration of drug release, and incomplete drug release are recurring problems. The possible agglomeration of bioactive agents on the surface of the fibers becomes a disadvantage of the electrospinning method since it can trigger an initial burst release, which may cause toxicity of the release site [48,224,235]. Such limitations may have implications in the scaffold biomedical goals.

To incorporate drugs into hydrogels, they can be loaded into the precursor solutions before crosslinking or can be absorbed after gelation [236]. Regarding drug release, swelling is an important property in some stimulus-sensitive drug delivery system. Certain changes in the environment may trigger swelling that allows the release of the drug due to the alterations in mesh size of the polymeric network [237]. Features like hydrophilicity, biocompatibility and tunable mechanical properties are the reason why hydrogels have been used extensively for the controlled release of drugs [193]. Although hydrogels are widely used in controlled release systems, there are some limitations that must be overcome. These scaffolds suffer from low mechanical resistance, which may be responsible for inhomogeneous release [236]. In most hydrogels, their ability to absorb large amounts of water and the presence of large pore sizes may trigger a rapid drug release [208]. In accordance, some investigations have developed/obtained better kinetic release profiles when there is a combination of hydrogels with other structures, namely fibers [193]. The effectiveness of fiber–hydrogel composites for drug administration has been demonstrated [208,227,228]. Nanofiber–hydrogel scaffolds as biofunctionalized platforms appear as attractive alternatives to the ineffective treatments related to direct drug administration.

Persistent neurological dysfunctions are usually triggered by spinal cord injuries due to failure in axon regeneration. Nguyen et al. synthesized lined mats of poly(ε-caprolactone-co-ethyl ethylene phosphate) (PCLEEP) by electrospinning and distributed them in a collagen hydrogel matrix. Both the fibers and the hydrogel contained neurotrophin-3 (model protein) known for promoting neuronal survival, axonal sprouting and regeneration. Additionally, the hydrogel contained miR-222 (model microRNA) known to contribute to the control of local protein synthesis at distal axons. Overtime, it was seen that degradation occurred within the collagen hydrogel, but the PCLEEP fibers maintained their morphology and alignment after 3 months. The composite framework allowed localized and sustained drug/gene delivery, while aligned nanofibers acted to direct remyelination of the injured area. Furthermore, they observed the regeneration of the animal model axon [227]. In a similar study, small fragmented nanofibers of poly(3-caprolactone-_co-_D,_L-lactide) (PCL:DLLA) and collagen were individually dispersed in a hyaluronane-methylcellulose hydrogel (HAMC). These fiber–hydrogel composites were used as a cell-transport system multipotent neural/progenitor stem cells (NSPCs) for the treatment of spinal cord injuries. The results showed that the incorporation of fibers in the HAMC hydrogel influenced the behavior of the NSPC cells, highlighting a better neuronal and oligodendrocytic differentiation in the scaffold PCL:DLLA/HAMC compared to collagen/HAMC [199]. In both studies, the complex generated from the combination of fibers and hydrogels allowed for a faster cell development and consequent regeneration.

A laminated fiber–hydrogel composite based on PCL electrospun fiber mats coupled with poly(ethylene glycol)-poly(ε-caprolactone) diacrylate (PEGPCL) hydrogels processed by UV polymerization was developed to control the release of a model hydrophilic protein (e.g., bovine albumin serum, BSA). To study the release of the hydrophilic protein, BSA was added to the system before crosslinking. The results reported by Han et al. suggested the relevant role of PLC fibers (diameter of approximately 0.45 μm) in the release of the drug in a uniform and delayed manner, by reducing swelling of hydrogels and water penetration rates and by increasing the length of the diffusion path and the diffusivity of the drug. In addition, the bioactivity of proteins after release was proven since extension of PC12 cell neuritis was detected. In general, the PCL fibers in the PEGPCL hydrogel demonstrated an important role in three main areas: control of the release kinetics of the hydrophilic protein, reduction of burst release (initial) and increased duration of drug release (more than two months) [193].

Osteomyelitis is a bone disease caused mainly by methicillin-resistant Staphylococcus aureus (MRSA). Various antibiotics are administered to reduce this infection, namely the glycopeptide vancomycin hydrochloride (vanco-HCl). The bacterial plaque that forms around the infected area limits treatment by preventing the diffusion of the antibiotic vanco-HCL to the infected site, which then requires the administration of high doses. This overuse of antibiotics in addition to their impropriate function can lead to systemic toxicity. To try and solve this problem, Ahadi et al. developed a scaffold made of poly(L-lactide) (PLLA) fibers produced by electrospinning followed by aminolysed, encased in a hydrogel of silk fibroin/oxidized pectin. PLLA fibers were loaded with vanco-HCl to promote a more sustainable release of the antibiotic at the affected site, resulting in a 61% reduction in drug release. This scaffold revealed better mechanical properties compared to the single hydrogel (without fibers), namely, a higher crosslinking density (52%), a higher compression module (30%) and a lower expansion rate (15%). Biologically, the fiber–hydrogel composite was seen to have activity against MRSA and to be cytocompatible with cells, largely due to the presence of fibers aminolized with drugs [208]. Ekaputra et al. developed by electrospinning/electrospraying a hybrid mesh of PCL/collagen and HA hydrogel, Heprasil^TM, loaded with vascular endothelial growth factors (VEGF) and platelet-derived growth factors (PDGF). It was seen that the fiber–hydrogel composite PCL/collagen-Heprasil was successful in allowing a double simultaneous loading of the growth factors VEGF165 and PDGF-BB and to promote their controlled release over a period of five weeks, in vitro [192]. Recently, biocompatible vehicles for the release of the crystal violet drug (CV) have also been described, in which polydopamine microfibers (PDA) were incorporated in a pullulan (PHG) hydrogel crosslinked by poly(ethylene glycol) diglicidyl ether (chemical crosslinker). PDA fibers attributed the pH-responsive drug release behavior to the PHG hydrogel. This happens in response to the acidic conditions, which increase the electrostatic repulsion force between the PDA (protonated and positively charged) and the drug CV (positive charge). This repulsion promotes the release of the drug, with a detectable a cumulative release of 60.3% (pH 7.4), which increased to 87% with a decrease in pH to 5. In addition, the incorporation of PDA fibers and the adjustment of their content allowed to regulate several properties of the composite PHG-PDAs, namely, its viscoelastic characteristics, mechanical performance, mesh size and swelling/disintegration properties of the PHG hydrogel. The developed scaffold proved to have great potential to be used in drug delivery systems, given its good cytocompatibility, non-toxicity and easily adjustable properties for a controlled release of CV [238]. Overall, data demonstrated the ability of the engineered systems to promote a controlled drug delivery, in which the fibrous mesh guaranteed the mechanical stability of the construct while the hydrogel released the loaded active compounds.

A new physical approach based on hydrogel and nanofibers (or NEEDs) for cell encapsulation has been described in the work of An et al. Here, tubular constructs with different compartments were developed, consisting of Nylon 6,6 nanofibers, manufactured by electrospinning, being subsequently impregnated in different hydrogel precursor solutions (alginate, chitosan or collagen) and crosslinked. Fibers had an average diameter of 200 nm with 1 μm interconnected pores. Compartmentation proved to be an asset for co-encapsulation, co-culture and co-distribution of different individual cells and cellular aggregates (islets), with cell viability being observed. Finally, the potential application of NEEDs for cell therapies using a type 1 diabetic model was tested, and the disease was corrected (in 8 weeks), which proved the therapeutic potential of NEEDs within primary rat islets (without the disease) [228].

In wound healing, it is important to pay attention to the biomaterials used to produce wound dressing. To achieve the desired objectives, the properties of each biomaterial are optimally combined. Studies have shown that local administration of therapeutic agents through wound dressings can improve the wound healing process [16]. In fact, a bioactive dressing of fibers of silk fibroin (SF) produced via electrospinning was developed and then combined with the alginate hydrogel (ALG) capable of supplying amniotic fluid (AF). This dressing had the ability to release AF, highly enriched with various therapeutic agents, at the wound site. The AF release profile was related to the concentration of ALG (greater release of AF in lower amounts of ALG). The increase in cell proliferation and collagen dissemination and secretion due to AF in fibroblast cultures strengthens the potential of the SF/ALG fiber–hydrogel composite to accelerate the healing process in severe wounds [239]. In a similar study, a bi-layer dressing of gelatin nanofiber mats loaded with epigallocatechin gallate (EGCG)/PVA hydrogel was produced for the treatment of acute wounds. The hydrogel was used as a protective and hydrating outer layer of the bi-layer dressing. Jaiswal el al. observed that the decrease in crosslinking time led to a slower EGCG release profile. This increased in the 2-4 days release period demonstrating the ability of this scaffold to guarantee a gradual drug release. Faster wound contraction, improvement in angiogenesis, reepithelization and less inflammatory response compared to control were also observed [240]. More recently, Chen et al. developed CS/gelatin hydrogels with polydopamine-intercalated silicate nanoflakes (PDA-Silicate). These were electrospun in the form of nanofibers loaded with the antibiotic tetracycline hydrochloride (TH). In this sandwich-like nanofiber/hydrogel composite (NF-HG) the incorporation of the fibers in the hydrogel resulted in a restriction in the release of antibiotic TH. However, it allowed a sustained release rate of TH in NF-HG for long-term protection. In addition, this structure reduced the toxicity of the drug associated to the rapid release. Furthermore, the excellent adhesiveness and anti-infectious properties demonstrated by the NF-HG, turned this formulation particularly attractive to be used as a wound dressing [241].