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Conventional pharmacological and physical therapies cannot fully restore uterine function. To overcome these limitations, we designed a composite, polysaccharide\u2010coated silk nanofiber film as a staged scaffold to meet evolving healing demands. The hydrophilic polysaccharide layer provides early postoperative wet strength, conformability and physical isolation, while the underlying nanofibrous silk network mimics the extracellular matrix to support cell adhesion, proliferation and regeneration in later stages. In a rat model of severe uterine injury, implantation of this biodegradable film prevented postoperative adhesions and preserved reproductive capacity, achieving a fertility rate exceeding 80%. Mechanistically, the scaffold modulates the immune microenvironment by promoting M2 macrophage polarization, attenuating inflammation and accelerating tissue repair. It also upregulates angiogenic factors (VEGF\u2010A, PDGF\u2010BB), enhances type III collagen deposition and minimizes foreign\u2010body reaction, collectively driving effective in situ uterine regeneration. Fabricated via aqueous electrospinning and mild coating, the scaffold is cost\u2010effective, ecofriendly and readily scalable. As a biodegradable, staged platform tailored to dynamic uterine healing, this material offers a novel, versatile solution for clinical translation in uterine repair and broader regenerative\u2010medicine applications.<\/jats:p>","DOI":"10.1002\/adhm.202502549","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T09:31:22Z","timestamp":1770370282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stage\u2010Adaptable Silk\u2010Based Nanofiber Film for Postoperative Uterine In Situ Repair and Fertility Preservation"],"prefix":"10.1002","volume":"15","author":[{"given":"Shujun","family":"Zhang","sequence":"first","affiliation":[{"name":"Research Centre of Printed Flexible Electronics School of Materials Science and Engineering Harbin Institute of Technology  Shenzhen China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changhong","family":"Linghu","sequence":"additional","affiliation":[{"name":"School of Mechanical &amp; Aerospace Engineering Nanyang Technological University  Singapore Singapore"},{"name":"Department of Mechanical Engineering College of Engineering City University of Hong Kong  Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Li","sequence":"additional","affiliation":[{"name":"National Engineering Laboratory for Modern Silk College of Textile and Clothing Engineering Soochow University  Suzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingxuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Materials Research Tsinghua Shenzhen International Graduate School Tsinghua University  Shenzhen P. 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