Conclusion
Every wound care clinician is periodically faced with the challenge of a wound that has entered an intransigent phase in relation to its healing end point. This stalled wound may be caused by a number of variable factors that collectively, or individually, halt the process of orderly healing. The progressive increase in the knowledge base related to biologic events occurring at the wound bed interface and to systemic nuances of chronic diseases, has provided clinicians direction in sequentially approaching, managing, and reversing this undesired event. Thus, once host factor-related chronic disease background is checked and controlled, the focus shifts to local wound factors adopting accepted principles of wound care to control the wound environment. If this fails to change the healing milieu, more sophisticated, specialized local wound interventions are introduced. Simultaneously, or following this approach, systemic additions to the program are made. This systematic approach to the stalled wound in individual steps, or collectively, would be expected to re-advance the wound to a normal healing pattern.