In the treatment of chronic, hard-to-heal wounds, managing destructive chronic wound exudate, removing devitalised tissue and addressing wound biofilm/infection are high priorities (Atkin et al, 2019). To optimise the rate and likelihood of a chronic wound healing, it is important to identify its cause and any factors that may impede the healing process (Wounds UK, 2018). This can only be achieved by undertaking holistic wound assessment followed by effective wound management — having a logical set of actions, or pathways to follow, aids this (Atkin et al, 2019; Box 1). When managing lower limb ulcers, accurate diagnosis is crucial so that they can be categorised as venous, arterial or mixed aetiology. The case study presented here highlights the care pathway of a mixed aetiology leg ulcer, including wound bed preparation.