Chronic wound healing is a complex, highly regulated process critical for maintaining skin barrier function. Chronic wounds, often resulting from underlying diseases like diabetes, are a significant burden on both patients and the healthcare system, costing over $25 billion annually in the US. This review discusses the physiology of wound healing, current treatments, and future directions. Wound healing involves three phases: inflammatory, proliferative, and remodeling. Factors such as oxygen supply, nutrition, and immune function are crucial for proper healing. Chronic wounds can result from various pathologic factors, including diabetes, vascular disease, and immune dysfunction. Wound infections are a major challenge, with topical antimicrobials and silver-based dressings being commonly used. However, overuse of antibiotics may lead to resistance and unnecessary costs. Wound dressings such as hydrocolloids, hydrogels, and alginate dressings are used to promote healing and prevent infection. Skin substitutes, including bioprosthetic materials, are used for severe wounds but are costly. Negative pressure wound therapy (NPWT) is effective in promoting healing by maintaining a moist environment and removing exudates. Growth factors, such as platelet-derived growth factor (PDGF), have shown some efficacy in wound healing, but their use is limited by cost and effectiveness. Hyperbaric oxygen therapy has shown modest benefits in healing diabetic foot ulcers but is not widely recommended. Future directions in wound healing include the use of stem cells, nitric oxide, and other novel therapies. Research continues to explore new treatments to improve wound healing outcomes and reduce the burden of chronic wounds.Chronic wound healing is a complex, highly regulated process critical for maintaining skin barrier function. Chronic wounds, often resulting from underlying diseases like diabetes, are a significant burden on both patients and the healthcare system, costing over $25 billion annually in the US. This review discusses the physiology of wound healing, current treatments, and future directions. Wound healing involves three phases: inflammatory, proliferative, and remodeling. Factors such as oxygen supply, nutrition, and immune function are crucial for proper healing. Chronic wounds can result from various pathologic factors, including diabetes, vascular disease, and immune dysfunction. Wound infections are a major challenge, with topical antimicrobials and silver-based dressings being commonly used. However, overuse of antibiotics may lead to resistance and unnecessary costs. Wound dressings such as hydrocolloids, hydrogels, and alginate dressings are used to promote healing and prevent infection. Skin substitutes, including bioprosthetic materials, are used for severe wounds but are costly. Negative pressure wound therapy (NPWT) is effective in promoting healing by maintaining a moist environment and removing exudates. Growth factors, such as platelet-derived growth factor (PDGF), have shown some efficacy in wound healing, but their use is limited by cost and effectiveness. Hyperbaric oxygen therapy has shown modest benefits in healing diabetic foot ulcers but is not widely recommended. Future directions in wound healing include the use of stem cells, nitric oxide, and other novel therapies. Research continues to explore new treatments to improve wound healing outcomes and reduce the burden of chronic wounds.