Chronic wounds, notably diabetic foot ulcers, venous leg ulcers, and pressure injuries, impose significant clinical and financial challenges worldwide due to persistent microbial colonization and poor healing. Bacterial cellulose (BC), produced by Komagataeibacter xylinus, is recognized for its purity, mechanical strength, and water retention, but lacks antimicrobial properties. To enhance its effectiveness, functionalization with silver nanoparticles (AgNPs) is suggested, as they provide antimicrobial and antibiofilm benefits. However, their use is restricted by issues of cytotoxicity and stability. This review comprehensively draws together progress from 2020 to 2025 on BC–AgNP composites as futuristic antimicrobial wound dressings. Major segments are dedicated to the discussion of synthesis methods (in situ, ex situ, electrochemical, and green methods), structure–property relationships and characterization techniques, juxtaposed with studies, in vitro, in vivo, and an emerging clinical scope of antimicrobial activity, cytocompatibility, and wound-healing efficacy. Recent advancements in hybrid composites with bioactive molecules, graphene oxide, or plant-derived reductants have been noted for their potential to reduce toxicity and enhance healing. Key challenges for clinical translation include issues with reproducibility, scalability, regulatory approval, and long-term safety. Future directions to address these obstacles involve eco-friendly synthesis methods, controlled silver release, multifunctional design, smart sensor integration, and large-scale trials. As a complete unit, BC–AgNP composites can be regarded as one group of composites which display a large potential in being developed as safe, efficient, and sustainable wound dressings for the treatment of chronic wounds.