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Abstract: The global demand for effective treatments of prevalent skin injuries has prompted the exploration into tissue engineering solutions. While 3D bioprinting has shown promise, challenges persist in achieving timely and compatible solutions for treating diverse skin injuries. In response, in situ bioprinting has emerged as a new avenue, reducing risks during implantation of printed scaffolds, and demonstrating superior therapeutic effects. However, maintaining printing fidelity in in situ bioprinting remains a critical challenge, particularly concerning model layering and path planning. This study proposes a novel optimization-based conformal path planning strategy for in situ bioprinting repair of complex skin injuries. The strategy employs constrained optimization to find optimal waypoints on the point cloud-approximated curved surface, ensuring the highest similarity between predesigned planar and surface-mapped 3D paths. Furthermore, this method demonstrates applicability to skin wound treatment, generating 3D equidistant zigzag curves along the surface tangent and enabling multilayer conformal path planning for volumetric injuries. The proposed algorithm proves feasible and effective in murine back injury model and other complex models, showcasing its potential to guide in situ bioprinting and enhance fidelity for improved clinical outcomes.