BACKGROUND: The prevalence of chronic wounds has been progressively increasing in the last few years, especially due to the raise of life expectancy and spreading of systemic diseases such as peripheral artery occlusive disease and diabetes mellitus (DM) among the Western world population. The degree of morbidity, mortality and economic burden associated with chronic wounds spreading is extremely relevant and demands an integrated, standardized, evidence-based approach to address to this matter. METHODS: The aim of this work was to recapitulate the current state of the art in chronic wounds management, with especial regard towards the most recent developments and their implementation. To this purpose, we described the clinical experience of the authors in a dedicated center and compared it with the most recent literature reviews available on this topic. RESULTS: Both experience and evidence point out that there are many interesting developments allowing for a better management of non-healing chronic ischemic wounds, the most promising of which is in our opinion the platelet-rich plasma gel. More advanced treatments, such as stem cell infusion, are still in need of further implementation. CONCLUSIONS: A standardized approach to chronic wounds should include a first-line treatment based on traditional methods (antimicrobials, surgical debridement, wound dressings) and a second-line based on advanced therapies (Vacuum therapy, growth factors, plasma gel, etc.) for non-healing chronic ulcers. © 2018 EDIZIONI MINERVA MEDICA.