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This case study is of an 82-year-old lady who was widowed and lives alone in a council house. A left lateral leg ulcer had developed over the gaiter area, and the community team were asked to assess in 2004. The main issues were her inability to tolerate compression (even when reduced) because of the pain. Nevertheless, the community nurses had tried very hard with compression, using different compression techniques at different times to try to encourage her to persevere. The nurses felt they were running out of ideas and therefore the tissue viability nurse (TVN) was asked to assess the wound. The TVN recommended ActiFormCool dressing. This article will examine the background for wound healing, provide the rational for the recommendation and describe the progress of the patient.