Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real‐time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label‐free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non‐invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.