Ho-ho-ho! Gather ’round, my little elves, for a tale of the tiny yet mighty Matrix metalloproteinases (MMPs), the little helpers of the body’s workshop known as the extracellular matrix (ECM). These zinc-clad elves are quite the busy bees, snipping away at the ECM to keep it in tip-top shape. But, oh my peppermint sticks, when they get too enthusiastic, they can cause a ruckus, leading to those pesky, non-healing chronic wounds that just won’t close up like a well-wrapped present.

In the land of chronic wounds, unlike the quick-to-mend acute ones, MMPs are always on the naughty list, with levels higher than the North Pole’s snowbanks due to inflammation. A variety of protease pranksters are to blame, but putting a stop to the MMPs’ shenanigans could very well turn the healing tides. Monitoring the levels of these mischievous MMPs can be like peeking at Santa’s list to see who’s been naughty or nice, giving us a clue on how the wound might fare.

Now, don’t get your tinsel in a tangle, but sometimes these wounds get an unwanted gift—a microbial infection. These bacterial bullies bring their own bag of proteases that can tell the host MMPs to kick it up a notch, making matters worse. To wrap up this problem, we need to target both the host’s and the bacteria’s proteases, like double-checking both the naughty and nice lists.

But there’s hope twinkling like the star atop the Christmas tree! Treatments that modulate MMP activity, like those superabsorbent polymer dressings, can be like leaving out a plate of cookies for Santa, improving the healing rates of these stubborn wounds. The main purpose of this festive review was to jingle all the way through the specific role of metalloproteinases in the pathology and therapy of hard-to-heal wounds, a story as important as the one about the night before Christmas!