Diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and pressure ulcers (PUs) represent the most common hard-to-heal wounds. According to Armstrong, “Every 1.2 seconds, someone develops a diabetic ulcer; every 20 seconds, someone is amputated.” In the United States, $1 million is spent every 30 seconds on diabetic foot complications. The news is similar for PUs; over a 10-year period, the number of PU treatments has increased 63%, costing $11 billion a year, data not indicative of improvement. Although 70% of small (<12.4 cm2) VLUs heal in 24 weeks, 30% do not. According to the literature, chronic, hard-to-heal wounds cost the US $50 billion per year, 10 times more than the annual budget of the World Health Organization. Fife and Carter call hard-to-heal wounds a silent epidemic that affects more than 6.5 million people in the US. The question is, Why do wounds fail to heal?...

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