Chronic wounds, including diabetic foot ulcers, venous leg ulcers, and pressure ulcers, pose significant challenges in wound care and consume substantial healthcare resources globally. This review discusses the pathophysiology of complex chronic wounds and the current methods and modalities available for achieving healing. Understanding the underlying pathophysiology and managing specific perturbations can lead to successful healing. Key factors contributing to delayed healing, such as excessive inflammation, persistent infections, and drug-resistant microbial biofilms, need to be addressed. Advanced therapies, including negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT), and biophysical modalities like electrical stimulation and ultrasound, have shown promise but lack robust evidence of efficacy. Biological and bioengineered therapies, such as platelet-rich plasma (PRP) and growth factor therapies, are also under investigation. The review emphasizes the importance of a comprehensive approach to wound care, including patient and wound assessment, proper wound bed preparation, and multidisciplinary management. Standard wound care principles should be followed before considering advanced therapies, with reassessment after 4 weeks of standard care if healing has not occurred.Chronic wounds, including diabetic foot ulcers, venous leg ulcers, and pressure ulcers, pose significant challenges in wound care and consume substantial healthcare resources globally. This review discusses the pathophysiology of complex chronic wounds and the current methods and modalities available for achieving healing. Understanding the underlying pathophysiology and managing specific perturbations can lead to successful healing. Key factors contributing to delayed healing, such as excessive inflammation, persistent infections, and drug-resistant microbial biofilms, need to be addressed. Advanced therapies, including negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT), and biophysical modalities like electrical stimulation and ultrasound, have shown promise but lack robust evidence of efficacy. Biological and bioengineered therapies, such as platelet-rich plasma (PRP) and growth factor therapies, are also under investigation. The review emphasizes the importance of a comprehensive approach to wound care, including patient and wound assessment, proper wound bed preparation, and multidisciplinary management. Standard wound care principles should be followed before considering advanced therapies, with reassessment after 4 weeks of standard care if healing has not occurred.