Implementing Wound Balance: Outcomes and future recommendations

Harikrishna K. R. Nair, Karen Ousey, Trent Brookshier, Emmanuelle Candas, Cornelia Erfurt-Berge, Sandrine Robineau, John Schäfer, Hans Smola, Laura Swoboda, Sharon Trouth
6 May 2025

Non-healing wounds can reduce quality of life (QoL) for millions of people globally, are costly, and result in significant patient, clinician and healthcare system burden (Guest et al, 2020; Ahmajärvi et al, 2022; Queen and Harding, 2023; Sen, 2023). There is a significant need to proactively address the projected rise of non-healing wounds by earlier intervention, resource optimisation and patient-centred care. 

The concept of ‘Wound Balance’ developed in 2023 can help address these unmet needs (Wounds International, 2023). Wound Balance aims to create a holistic picture of the patient and their wound so clinicians can achieve a balance between the many facets of wound care planning and achievable goals.

Effective patient communication has long been identified as a major goal (King and Hoppe, 2013; Wang et al, 2020). Most people with chronic wounds receive their treatment in either community or nursing/home-care settings (Lindholm and Searle, 2016; Blome et al, 2024). This consensus publication presents the findings from a global network of wound care clinicians who have implemented Wound Balance in their clinical settings for a variety of wound aetiologies. It aims to provide practical tips and actionable insights for wound care clinicians around the world in implementing and achieving Wound Balance for their patients. 

A major focus of this consensus is to provide patient communication strategies for wound care clinicians in these settings. However, recommendations from this consensus are equally applicable to all wound care practitioners in all clinical settings, including podiatrists, vascular specialists, general physicians and acute care clinicians. 

Harikrishna K. R. Nair, Chair 

Download the full consensus document below

Disclaimer: This resource has been supported by HARTMANN
References

Ahmajärvi K, Isoherranen K, Venermo M (2022) Cohort study of diagnostic delay in the clinical pathway of patients with chronic wounds in the primary care setting. BMJ Open 12(11): e062673

Alnaser F (2020) Effective communication skills and patient’s health. CPQ Neurol Psychol 3(4): 1-11

Anghel EL, DeFazio MV, Barker JC et al (2016) Current Concepts in Debridement: Science and Strategies. Plast Reconstr Surg 138(3 Suppl): 82S-93S

Armstrong DG, Jude EB (2002) The role of matrix metalloproteinases in wound healing. J American Pod Med Assn 92(1): 12-8

Atkin L, Bućko Z, Conde Montero E et al (2019) Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 23(Sup3a): S1-50

Atkin L, Barrett S, Chadwick P et al (2020) Evaluation of a superabsorbent wound dressing, patient and clinician perspective: a case series. J Wound Care 29(3): 174-82

Avishai E, Yeghiazaryan K, Golubnitschaja O (2017) Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalised medicine. EPMA J 8(1): 23-33

Ayavoo T, Murugesan K and Gnanasekaran A (2021) Roles and mechanisms of stem cell in wound healing. Stem Cell Investig 8: 4

Ball C, Taylor C, Salgado B et al (2025) In vitro evaluation of the capability of a silicone superabsorbent polymer (SAP) dressing to modulate pro-inflammatory cytokines. Wounds Int 16(2): 12-23

Bhattad PB, Pacifico L (2022) Empowering Patients: Promoting Patient Education and Health Literacy. Cureus 14(7): e27336

Blome C, Baade K, Debus ES et al (2014) The “Wound-QoL”: a short questionnaire measuring quality of life in patients with chronic wounds based on three established disease-specific instruments. Wound Repair Regen 22(4): 504-14

Blome C, Candas E, Erfert-Berge C et al (2024) Implementing the Wound Balance concept into routine practice worldwide. Wounds Int 15(2): 44-50

Boniol M, Kunjumen T, Nair TS et al (2022) The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Glob Health 7(6): e009316

Buchstein N, Hoffmann D, Smola H et al (2009) Alternative proteolytic processing of hepatocyte growth factor during wound repair. Am J Pathol 174(6): 2116-28

Candas E, Forster J, Schäfer J et al (2021) HydroClean® Made Easy. Wounds International

Carter MJ, DaVanzo J, Haught R et al (2023) Chronic wound prevalence and the associated cost of treatment in Medicare beneficiaries: Changes between 2014 and 2019. J Med Econ 26(1): 894-901

Choo J, Nixon J, Nelson A (2019) Autolytic debridement for pressure ulcers. Cochrane Database Syst Rev 2019(6): CD011331

Cullen B, Gefen A (2023) The biological and physiological impact of the performance of wound dressings. Int Wound J 20(4): 1292-303

Dissemond J, Protz K, Erfurt-Berge C et al (2022a) Wundbehandlung ohne kurative Zielsetzung: Ein Positionspapier der Initiative Chronische Wunden (ICW) e. V [Wound treatment without curative intention: position paper of the Initiative Chronische Wunden (ICW) e. V.]. Dermatologie (Heidelb) 73(7): 550-5

Dissemond J, Malone M, Ryan H et al (2022b) Implementation of the M.O.I.S.T. concept for the local treatment of chronic wounds into clinical practice. Wounds International 13(4): 34–43

Eming SA, Koch M, Krieger A, et al (2010) Differential proteomic analysis distinguishes tissue repair biomarker signatures in wound exudates obtained from normal healing and chronic wounds. J Proteome Res 9(9): 4758-66

Erfurt-Berge C, Michler M, Renner R (2021) Versorgungszustand von Patienten vor Zuweisung an ein universitäres Wundzentrum [Standard of patient-centred care before admission to a university wound centre]. Hautarzt 72(6): 517-24

Eriksson E, Liu PY, Schultz GS et al (2022) Chronic wounds: Treatment consensus. Wound Repair Regen 30(2): 156-71

Fletcher J, Edmonds M, Madden J et al (2024) Demystifying infection in the diabetic foot.
Wounds UK

Gao M, Guo H, Dong X et al (2024) Regulation of inflammation during wound healing: the function of mesenchymal stem cells and strategies for therapeutic enhancement. Front Pharmacol 15: 1345779

Gefen A, Alves P, Beeckman D et al (2024) How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs. Adv Wound Care (New Rochelle) 13(1): 34-52

Giguère A, Zomahoun HTV, Carmichael PH et al (2020) Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 8(8): CD004398

Gould L, Abadir P, Brem H et al (2015) Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc 63(3): 427-38

Guest JF, Fuller GW, Vowden P (2020) Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open 10: e045253

Herrick S, Ashcroft G, Ireland G et al (1997) Up-regulation of elastase in acute wounds of healthy aged humans and chronic venous leg ulcers are associated with matrix degradation. Lab Invest
77(3): 281-8

Holm A, Karlsson V, Dreyer P (2021) Nurses’ experiences of serving as a communication guide and supporting the implementation of a communication intervention in the intensive care unit. Int J Qualitative Stud Health Well-being 16(1): 1971598

House of Lords Hansard (2021) Written Statements and Written Answers Session 2019-21, No. 175 21 January 2021. Available at: https://hansard.parliament.uk/commons/2021-01-21 (accessed 05.02.2025)

Janke TM, Kozon V, Valiukeviciene S et al (2024) Assessing health-related quality of life using the Wound-QoL-17 and the Wound-QoL-14-Results of the cross-sectional European HAQOL study using item response theory. Int Wound J 21(8): e70009

Kandhwal M, Behl T, Singh S et al (2022) Role of matrix metalloproteinase in wound healing. Am J Transl Res 14(7): 4391-405

Kapp S, Santamaria N (2017) The financial and quality-of-life cost to patients living with a chronic wound in the community. Int Wound J 14(6): 1108-19

Khalid KA, Nawi AFM, Zulkifli N et al (2022) Aging and Wound Healing of the Skin: A Review of Clinical and Pathophysiological Hallmarks. Life (Basel) 12(12): 2142

King A, Hoppe RB (2013) “Best practice” for patient-centered communication: a narrative review. J Grad Med Educ 5(3): 385-93

Krzyszczyk P, Schloss R, Palmer A, Berthiaume F (2018) The Role of Macrophages in Acute and Chronic Wound Healing and Interventions to Promote Pro-wound Healing Phenotypes. Front Physiol 9: 419

Langemo D, Faan RN, Campbell K et al (2021) Applying Frailty Syndrome to the Skin: A Review and Guide for Prevention and Management. Adv Skin Wound Care 34(8): 444-7

Lauer G, Sollberg S, Cole M et al (2000) Expression and proteolysis of vascular endothelial growth factor is increased in chronic wounds. J Invest Dermatol 115(1): 12-8

LeBlanc K, Woo K (2022) A pragmatic randomised controlled clinical study to evaluate the use of silicone dressings for the treatment of skin tears. Int Wound J 19(1): 125-34

Lindholm C, Searle R (2016) Wound management for the 21st century: combining effectiveness and efficiency. Int Wound J 2(Suppl 2): 5-15

Lindley LE, Stojadinovic O, Pastar I (2016) Biology and Biomarkers for Wound Healing. Plast Reconstr Surg 138(3 Suppl): 18S-28S

Lumbers M (2019) TIMERS: undertaking wound assessment in the community. Br J Community Nurs 24(Sup12): S22-S25

Mamun AA, Shao C, Geng P (2024) Recent advances in molecular mechanisms of skin wound healing and its treatments. Front Immunol 15: 1395479

Mayer DO, Tettelbach WH, Ciprandi G et al (2024) Best practice for wound debridement. J Wound Care 33(Sup6b): S1-32

Mikosiński J, Kalogeropoulos K, Bundgaard L (2022) Longitudinal Evaluation of Biomarkers in Wound Fluids from Venous Leg Ulcers and Split-thickness Skin Graft Donor Site Wounds Treated with a Protease-modulating Wound Dressing. Acta Derm Venereol 102: adv00834

National Library of Medicine (2022) Chronic wounds: Learn More – What are the treatment options for chronic wounds? Available at: https://www.ncbi.nlm.nih.gov/books/NBK326436/ (accessed 257.01.2025)

National Library of Medicine (2023a) Wound physiology. Available at: https://www.ncbi.nlm.nih.gov/books/NBK518964/ (accessed 10.01.2025)

National Library of Medicine (2023b) Wound dehiscence. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551712/#:~:text=The%20causes%20of%20dehiscence%20are,or%20drainage%20at%20the%20site. (accessed 04.02.2025)

National Library of Medicine (2023c) Wound debridement. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507882/#:~:text=Debridement%20for%20most%20wounds%20is,stimulating%20activity%20of%20growt (accessed 04.02.2025)

National Library of Medicine (2025) Wound Assessment. Available at: https://pubmed.ncbi.nlm.nih.gov/29489199/ (accessed 27.01.2025)

National Institute for Health and Care Excellence (2024) Leg ulcer – venous. Available at: https://cks.nice.org.uk/topics/leg-ulcer-venous/#:~:text=A%20venous%20leg%20ulcer%20occurs,ankle%20to%20mid%2Dcalf) (accessed 27.01.2025)

Nwomeh BC, Yager DR, Cohen IK (1998) Physiology of the chronic wound. Clin Plastic Surgery 25(3): 341-56

Olsson M, Järbrink K, Divakar U et al (2019) The humanistic and economic burden of chronic wounds: a systematic review. Wound Repair Regen 27(1): 114-125

Ousey K, Rogers AA, Rippon MG (2016) HydroClean® plus: a new perspective to wound cleansing and debridement. Wounds UK 12(1): 78-87

Pađen L, Gschwind G, Vettorazzi R (2024) Facilitators and barriers for nurses when educating people with chronic wounds – A qualitative interview study. J Tissue Viability 33(2): 174-78

Patel S, Maheshwari A, Chandra A (2016) Biomarkers for wound healing and their evaluation. J Wound Care 25(1): 46-55

Probst A (2019) Zetuvit Plus Silicone Border Made Easy. Wounds International

Queen D, Harding K (2023) What’s the true costs of wounds faced by different healthcare systems around the world? Int Wound J 20(10): 393538

Raziyeva K, Kim Y, Zharkinbekov Z, Kassymbek K (2021) Immunology of Acute and Chronic Wound Healing. Biomolecules 11(5): 700

Sawaya AP, Stone RC, Brooks SR (2020) Deregulated immune cell recruitment orchestrated by FOXM1 impairs human diabetic wound healing. Nat Commun 11(1): 4678

Schilrreff P, Alexiev U (2022) Chronic Inflammation in Non-Healing Skin Wounds and Promising Natural Bioactive Compounds Treatment. Int J Mol Sci 23(9): 4928

Sen CK (2023) Human Wound and Its Burden: Updated 2022 Compendium of Estimates. Adv Wound Care 12: 657-70

Sharkiya SH (2023) Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res 23(1): 886

Shi C, Wang C, Liu H et al (2020) Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 8: 182

Sibbald RG, Elliott JA, Persaud-Jaimangal R (2021) Wound Bed Preparation. Adv Skin Wound Care 34(4): 183-95

Stacey MC, Phillips SA, Farrokhyar F (2019) Evaluation of wound fluid biomarkers to determine healing in adults with venous leg ulcers: a prospective study. Wound Repair Regen 27(5): 509-18

Swoboda L. Multi-layer silicone SAP dressing for wound prophylaxis. Presented at Symposium on Advanced Wound Care (poster EBP-018)
Las Vegas, Nevada, 2-5 October 2024

Tickle J (2013) Living day-to-day with a heavily exuding wound: Recommendations for practice. Wounds UK 8(1):77-78

Trengove NJ, Bielefeldt-Ohmann H, Stacey MC (2000) Mitogenic activity and cytokine levels in non-healing and healing chronic leg ulcers. Wound Repair Regen 8(1): 13-25

Trouth S (2024) Introducing Wound Balance: placing the patient at the heart of wound healing. Wounds UK 20(1): 32-7

Ulrich D, Lichtenegger F, Unglaub F et al (2005) Effect of chronic wound exudates and MMP-2/9 inhibitor on angiogenesis in vitro. Reconstr Surg 116(2): 539-45

von Stülpnagel CC, da Silva N, Augustin M et al (2021) Assessing the quality of life of people with chronic wounds by using the cross-culturally valid and revised Wound-QoL questionnaire. Wound Repair Regen 29(3): 452-59

Veličković VM, Chadwick P, Rippon MG (2020) Cost-effectiveness of superabsorbent wound dressing versus standard of care in patients with moderate-to-highly exuding leg ulcers. J Wound Care 29(4): 235-46

Veličković VM, Prieto PA (2022) Superabsorbent wound dressings versus foams dressings for the management of moderate-to-highly exuding venous leg ulcers in French settings: An early stage model-based economic evaluation. J Tissue Viability 31(3): 523-30

Veličković VM, Lembelembe JP, Cegri F et al (2023) Superabsorbent Wound Dressing for Management of Patients With Moderate-to-Highly Exuding Chronic Leg Ulcers: An Early Stage Model-Based Benefit-Harm Assessment. Int J Low Extrem Wounds 22(2): 345-52

Veličković V M, Macmillan T, Lones E (2024) Systematic review and quality assessment of clinical and economic evidence for superabsorbent wound dressings in a population with chronic ulcers. Int Wound J 21(3): e14750

Walker M (2022) Human skin through the ages. Int J Pharm 622: 121850

Wang D, Liu C, Zhang X (2020) Do Physicians’ Attitudes towards Patient-Centered Communication Promote Physicians’ Intention and Behavior of Involving Patients in Medical Decisions? Int J Environ Res Public Health 17(17): 6393

World Health Organization (2025) Health workforce. Available at: https://www.who.int/health-topics/health-workforce#tab=tab_1 (accessed 25.1.2025)

Wounds International (2019) Wound exudate. Effective assessment and management. Wounds International, London. Available to download from www.woundsinternational.com

Wounds International (2023) Wound Balance: achieving wound healing with confidence. Wounds International, London. Available to download from www.woundsinternational.com

Wounds International (2024) Surgical wound dehiscence (SWD): International consensus statement on assessment, diagnosis and management. Wounds International, London. Available to download from www.woundsinternational.com

Zhu X, Olsson MM, Bajpai R (2022) Health-related quality of life and chronic wound characteristics among patients with chronic wounds treated in primary care: A cross-sectional study in Singapore. Int Wound J 19(5): 1121-32

Free for all healthcare professionals

Sign up to the Wounds Group journals





By clicking ‘Subscribe’, you are agreeing that the Wounds Group are able to email you periodic newsletters. You may unsubscribe from these at any time. Your info is safe with us and we will never sell or trade your details. For information please review our privacy policy.

Are you a healthcare professional? This website is for healthcare professionals only. To continue, please confirm that you are a healthcare professional below.

We use cookies responsibly to ensure that we give you the best experience on our website. If you continue without changing your browser settings, we’ll assume that you are happy to receive all cookies on this website. Read about how we use cookies.

I am not a healthcare professional.