Aim: Chronic lower limb ulceration is a significant clinical challenge, particularly when complicated by comorbidities, infection and failure of surgical intervention. This case study shows how specialist-led conservative management supported limb salvage, even when reconstructive surgery and amputation were being considered. Methods: A 57-year-old man with obesity, hypertension and a complex history of left lower limb trauma and soft tissue reconstruction was referred to a specialist lower limb therapy service following failure of a split-thickness skin graft. Occupational demands limited standard compression options. The patient had recurrent graft failure, local infection and progressive wound deterioration, with significant psychosocial distress. Specialist conservative management included structured wound bed preparation, use of high-level short-stretch compression, and an antimicrobial moisture balance dressing. Results: Intensified management resulted in progressive improvement. Following initiation of Suprasorb® X + PHMB, wound moisture balance improved, granulation tissue developed over previously exposed muscle and wound depth reduced. Although plastics review recommended complex free flap reconstruction, with a possibility of below-knee amputation, continued healing supported further conservative management. Approximately 98% epithelialisation was achieved, with healthy periwound skin and limb salvage considered a realistic outcome. Conclusion: Surgical failure is not necessarily the end of the healing pathway. Sustained specialist input, high-level compression therapy and antimicrobial moisture balance dressings can support healing in complex lower limb wounds and may help avoid amputation.