All of us in wound care are struggling to understand the rationale for limiting patients to 4 applications of a skin substitute when the patients in the clinical trials used to rationalize “medically necessary” products (Group 2) were both healthier than “real world” patients and were given 10 or more applications to achieve closure. Caroline Fife, M.D. highlights a concerning discrepancy between the characteristics of patients with chronic wounds in real-world settings and those selected for clinical trials.