Purpose <p>Wound healing in extreme environments—such as high temperature, humidity, salinity, intense sunlight, and radiation—is hindered by intensified inflammation, microbial growth, and impaired cellular activity. Conventional dressings cannot often protect tissues or adapt to such challenges. This review aims to analyze strategies for designing hydrogel dressings that can either mitigate these adverse conditions or harness them to promote repair and to highlight recent innovations with potential clinical impact.</p> Methods <p>A comprehensive search of recent literature was performed, focusing on hydrogel-based wound dressings engineered for high-temperature, high-humidity, high-salinity, and radiation-exposed settings. Representative advances, including bioengineered live hydrogels and materials optimized through artificial intelligence, were examined to illustrate current approaches and emerging trends in this field.</p> Results <p>Hydrogel dressings, with their biomimetic extracellular matrix structure and tunable functionality, provide superior moisture retention, antimicrobial action, and adaptability under harsh conditions. Novel formulations integrate antioxidant, anti-inflammatory, or light-responsive components, while living-cell and AI-designed hydrogels further enhance regenerative potential. These developments demonstrate promising effectiveness in preclinical models and underscore opportunities for tailored wound care in challenging contexts.</p> Conclusion <p>Hydrogel dressings represent a versatile platform for wound management under extreme conditions. Addressing scalability, long-term safety, and clinical translation will be essential to realize their applications in military medicine, disaster response, and space health.</p>