Sprayable hydrogels have emerged as a transformative innovation in biomedical technology, offering a versatile, efficient, and minimally invasive platform for various clinical applications. They form gels in situ upon tissue contact, enabling seamless application on even complex surfaces. This property is especially useful in wound care, drug delivery, and tissue engineering, where localized and sustained release of therapeutics is essential. Formulations can be customized to include various bioactive compounds, such as growth factors, antibiotics, and anti-inflammatory agents, thereby enhancing targeted treatment outcomes. This review delves into the fundamental principles governing sprayable hydrogels, emphasizing critical mechanisms such as in situ cross-linking, shear-thinning properties, and thermoresponsive behavior. Furthermore, it highlights recent advancements since 2020, including the strategic incorporation of bioactive agents to augment therapeutic efficacy. By examining these core mechanisms and design strategies, this review provides a comprehensive perspective on the engineering of sprayable hydrogels for modern medical applications.