BIOMES™: Early Identification of Barriers to Wound Healing

Download the BIOMES™ Tool (PDF)

Why Early Identification Matters

  • Chronic and hard‑to‑heal wounds often show red flags within the first 24–48 hours, not 12 weeks later.
  • Early recognition of impaired blood flow, infection, heavy exudate, metabolic complications, or social barriers can drastically change outcomes.
  • Many wounds are first seen in ED, primary care, urgent care, or home health—often by clinicians without specialized wound training.
  • BIOMES™ provides a simple, reliable, and defensible framework to support early referral, rapid intervention, and better healing trajectories.

The Six Barriers That Most Often Stall Wound Healing

BIOMES™ highlights the root causes—not just symptoms—giving clinicians a rapid, structured way to classify a wound as low, moderate, or high risk and determine whether early specialist involvement is needed.

  • B – Peripheral arterial disease, ischemia, impaired perfusion
    Assess: Pulses, Refill, Capillary Skin temperature, Edema
  • I – Local infection, biofilm, cellulitis
    Assess: Redness, Drainage, Odor, Delayed healing
  • O – Pressure, shear, mechanical trauma
    Assess: Pressure, Shear/Friction, Offloading devices Neuropathy
  • M – Diabetes, renal disease, obesity, medications
    Assess: Heart disease, Diabetes, Immunosuppression, Nutrition
  • E – Heavy drainage, inflammatory exudate, venous congestion
    Assess: Exudate volume, Type of exudate
  • S – Access to care, transportation, adherence, support
    Assess: Support systems, Quality of life, Smoking

How to Use BIOMES™ — Simple Scoring for Smarter Decisions

BIOMES™ highlights the root causes—not just symptoms—giving clinicians a rapid, structured way to classify a wound as low, moderate, or high risk and determine whether early specialist involvement is needed
Download the BIOMES™ Tool

Scoring:

  • 0 BIOMES → LOW RISK
    Continue care; refer if minimal progress after 2 weeks.
  • 1 BIOMES → MODERATE RISK
    Address barrier, consider referral; escalate if no clear progress in 2 weeks.
  • 2+ BIOMES → HIGH RISK
    Do not delay — refer today to a wound specialist.

Why it Works:

  • Standardizes assessment across varied clinical settings
  • Helps clinicians quickly understand healing risk
  • Creates a defensible referral rationale
  • Aligns with Wound Balance and TIMERS
  • Supports earlier adoption of advanced therapies where clinically indicated

How BIOMES™ Was Developed

The framework for BIOMES™ was developed by Trent Brookshier, DPM, based on the Wound Balance concept, to help clinicians recognize early when wounds are at risk for delayed healing. The framework reflects key clinical domains that consistently disrupt wound balance and signal the need for early intervention or referral. Building on this framework, Hartmann USA developed the BIOMES™ Tool in collaboration with Dr. Brookshier, translating the clinical concept into a simple, point‑based screening tool that can be used by any clinician at the first patient encounter. The result is a practical tool designed to support timely decision‑making, early referral, and more confident wound care.
“The BIOMES framework was created to help clinicians recognize early when wounds are unlikely to heal as expected—so action can be taken before healing stalls.”

— Trent Brookshier, DPM
Developer of the BIOMES™ framework

Clinical Impact of BIOMES™

With BIOMES™, clinicians move from “managing wounds” to actively restoring healing — the core of Wound Balance, our proactive approach built with global wound specialists.

Learn more about Wound Balance

BIOMES tool in action webinar

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Aptos;mso-ligatures:standardcontextual;mso-ansi-language:EN-US;mso-fareast-language:
EN-US;mso-bidi-language:AR-SA">WoundCon Spring 2026 featured a webinar on
the BIOMES tool in action with the title A Case-Based Approach to
Early Wound Intervention Using a Novel Silicone Superabsorbent Polymer
presented by Laura Swoboda, DNP, Trent Brookshier, DPM and Joseph C.
Rudolph, MSN.

Watch the WoundSource BIOMES webinar

Download the BIOMES tool

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Early Intervention Dressings

Learn more about our early intervention Silicone SAP dressing Zetuvit® Plus Silicone Border.
Learn more about Zetuvit® Plus Silicone Border