The microcirculation has a substantial role in wound healing, as it provides oxygen and proliferative/immunological mediators necessary to the healing process. In this chapter, we discuss the concept of the wound as a temporary added “organ” due to its increased metabolic needs and how the microcirculation functions as a reserve to support healing. We provide a brief overview of the normal healing process, including the factors driving angiogenesis, and address the differences in the microarchitecture of the skin’s circulation. While microcirculation is a highly plastic system, we consider aspects that may contribute to dysfunctional perfusion to the skin, such as aging and other pathologies, and their consequences in delayed healing and the development of ulcers. This chapter will provide an in-depth explanation of the structure and physiology of microcirculation in the paradigm of the healing process and address the role of microcirculation in some of the most common chronic and often difficult to heal wounds including venous, arterial, neuropathic, diabetic, and pressure ulcers.