Purpose This paper aims to review the technological developments, cutting-edge applications and future trends of flexible surface acoustic wave (SAW) sensors. Design/methodology/approach Through a systematic analysis of three mainstream technical routes – thinning of rigid materials, thin-film integration on flexible substrates and intrinsically flexible materials – along with their applications in wearable technology, robotic sensing, biochemical sensing and structural health monitoring, this review is conducted. Findings The study clarifies that the three technical routes involve distinct trade-offs in performance, flexibility and fabrication processes. Flexible SAW sensors developed based on these routes demonstrate unique advantages, such as wireless and passive operation and conformal attachment, across multiple emerging fields. Originality/value This paper systematically compares the three major technical routes for flexible SAW sensors, integrates their cross-domain applications and outlines future development directions in materials, structures and system integration.