As mentioned earlier, chronic wounds afflict many people around the world. The most problematic aspect is that these wounds may persist for months or even years without healing or showing signs of improvement. In the case of chronic wounds, the core problem is not the wound itself, but its underlying cause. This is why treating the wound alone often fails to completely resolve the wound in many cases. In general, there are three basic factors that contribute to the failure of a wound to heal: 1) circulatory disturbances, which can prevent fresh, oxygen-rich blood from reaching the wound bed; 2) infections, such as cellulitis, which can destroy the collagen component before new tissue can form; and 3) edema, which can result in the loss of the collagen component of the wound necessary for the growth of new tissue. Wound healing can be significantly improved by reducing edema and increasing oxygen-rich blood perfusion. Hyperbaric oxygen therapy has been shown to improve wound healing by 30% to 50% and prevent recurrence. Chronic wounds can be caused by many clinical reasons, but in general, the common causes include: 1, chronic diseases: many chronic diseases affect the normal wound healing process, especially diabetes; 2, poor blood perfusion: so that the supply of blood to the limb tissues is reduced; 3, old age: the skin of the elderly due to the elasticity of the skin with the age of the decreasing more susceptible to damage; 4, obesity or poor health conditions; 5, Prolonged localized pressure on the body: pressure sores or bedsores. Clinically, a number of diseases can cause these health conditions and lead to chronic wounds, including: anemia, intestinal diseases, chronic osteomyelitis, atherosclerosis, diabetes, heart disease, high cholesterol, hypertension, renal insufficiency syndrome, lymphedema, malnutrition, obesity, and poor blood perfusion. On a more specialized level, in addition to poor circulation, neuropathy, and mobility difficulties, chronic trauma is influenced by systemic disease, age, and recurrent injuries. Primary diseases such as vasculitis, immunosuppression, gangrenous pyoderma, and diseases that can lead to local ischemia can also lead to the development of chronic wounds. Immunosuppression can be secondary to certain diseases or prolonged use of certain medications, such as steroids. Emotional stress can also affect wound repair, and the cause may be related to elevated blood pressure and up-regulation of corticosteroid levels, which can reduce immunity. Chronic wounds can also be caused by certain malignant lesions, such as cancerous tissue that can continue to grow until the blood can no longer supply the cells, resulting in the development of an ulcer. Chronic wounds may also become cancerous, especially squamous cell carcinoma, and the cause may be related to the rapid proliferation of cells stimulated by repeated injury. Advanced age is another cause of chronic wounds. Elderly people are more susceptible to skin damage and also have slower cell proliferation and less ability to upregulate the expression of stress-related proteins. It has been reported in the literature that elderly cells overexpress stress-related genes in a non-stressed state, but when stress occurs, their ability to express these stress proteins is significantly lower than that of younger cells. In addition, a number of comorbid factors that may cause tissue ischemia are more likely to trigger chronic trauma. These factors include chronic fibrosis, atherosclerosis, edema, anemia, and poor vascular perfusion. Repeated local injuries also play a role in chronic wound formation by continuously initiating an inflammatory cascade. In summary, the variety of factors that contribute to the pathogenesis of chronic wounds is one of the reasons why chronic wounds are so difficult to treat. Therefore, in the management of chronic wounds, it is important to keep in mind that the core problem of chronic wounds is not the wound itself, but the underlying etiology. In other words, it is the treatment of the underlying factors that may be the key to a satisfactory outcome.