Bacterial biofilm is increasingly suspected as being a significant barrier to wound healing. Bacteria predominantly attach to surfaces in their natural habitats and form biofilm; in this state they adapt to, and tolerate, the hostilities in their surrounding environment. The purpose of this clinical observational study was to consider chronic wound biofilm in relation to other factors that are implicated in wound recalcitrance, such as peripheral arterial disease, wound infection, osteomyelitis and moisture imbalance. Based on our clinical observations, it is possible that links exist between wound biofilm and other underlying pathophysiological factors, and that biofilm may also provide clues to the involvement of such factors. Recognising and managing these factors collectively may be important in addressing recalcitrance and facilitating wound progression.