Good morning. I don't have enough information for this patient. My typical work up: arterial studies, venous studies, biopsy and wound culture. Review of medical records. Assuming that is completed. History/Exam: is wound painful, associated with necrosis, does wound worsen after debridement. Drainage yes or no? Smell Yes or no? Color of exudate? Is this colonized vs infected? Differential diagnosis: Typical or atypical wound, venous or other? Management: Assuming you have addressed above; Debride and address bioburden vs infection/biofilm(I will be generic on product selection). If you have access to ultrasonic debridement would be a great choice. Then of course dealing with drainage and exudate control, and degree of compression. Assuming that you have excluded all the other areas per above discussion, not sure if this pt has lymphedema, other reasons for poor healing (DM, Cancer, Nutrition smoking cessation, etc).
When I have a wound that is challenging, not improving, I take a step back and reevaluate all areas and concerns for not healing.