The problem of delayed wound healing has been highlighted in several publications which has stimulated debate on variance and the need for updated care pathways. This paper demonstrates how adjunctive therapy can be added to the ‘standard care’ model, described in the National Wound Care Strategy Programme’s recommendations for lower limb wounds, to enhance outcomes for patients with ‘hard-to-heal’ lower limb wounds (NWCSP, 2020). A decision-making pathway based on published literature is described,  which uses wound assessment and observed response to treatment to allow the effective and targeted introduction of adjunctive therapies for ‘hard-to-heal’ wounds. This approach will allow the cost-effective introduction of new and evolving therapies, such as WoundExpress™(Huntleigh Healthcare), which addresses the underlying problems associated with resistant lower limb oedema and compromised venous function. The pathway also indicates how other adjunctive or innovative topical wound-based treatments can be integrated to optimise outcomes while providing cost-effective care.