Wounds that cannot be treated with conventional wound care procedures or those that do not become sufficiently smaller with 6 weeks of treatment are usually considered for reconstructive procedures. The present study reviews surgical procedures based on the reconstructive ladder used for the treatment of difficult wounds that contain cavities or are located on vital organs or tissues and do not heal with standard wound care. This review, which highlights that using conventional techniques in such wounds may be a waste of time and money, is intended to guide health professionals dealing with difficult wounds.