Biofilm: Colonies of multiphenotype, free-floating bacteria that secrete a polysaccharide matrix that protects the bacteria from immune response and antibiotics.

Chronic wounds: Wounds that stall in the inflammation phase and fail to progress toward healing within 3 months are considered chronic or hard to heal.

Continuous inflammation: When wound healing becomes stalled in the inflammatory phase because of the presence of bacteria and their endotoxins, the wound is unable to move out of the inflammatory phase and into the repair phase.

Endotoxins: Substances that are present on the cell wall of gram-negative bacteria and cause an inflammatory response even in small amounts.

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Inflammation phase: The phase of wound healing following hemostasis. The inflammation phase is meant to control bleeding and prevent infection by sending repair cells to the wound site to remove debris and bacteria. This process may cause swelling, heat, pain, and redness in the wound area. This is the phase of wound healing where stalling happens, causing chronic or hard-to-heal wounds.

Microbiome: The community of organisms that live on the surface of the skin, such as bacteria, viruses, arthropods, and others.

Polysaccharide matrix: A substance secreted by biofilms that is made up of proteins, poly saccharides, and extracellular DNA and that provides protection from immune responses and antibiotics.

Proinflammatory cytokine: An immunoregulatory cytokine that favors inflammation. The net effect of an inflammatory response is determined by the balance between proinflammatory and anti-inflammatory cytokines.

Senescent cells: Cells that appear during late-stage healing and that release a continual cascade of inflammatory cytokines, chemokines, growth factors, and proteases. The presence of these cells may prolong the inflammatory period.

TIMERS: A framework for wound bed preparation to help resolve stalling factors in wound healing. It includes tissue management, inflammation, moisture balance, edge or epithelial advancement, repair or regeneration, and social factors.