1
|
Gefen A. The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers. J Wound Care 2024; 33:620-628. [PMID: 39287029 DOI: 10.12968/jowc.2024.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVE The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the Journal of Wound Care. A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents. METHOD The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices. RESULTS Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin. CONCLUSION This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.
Collapse
Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Mathematics and Statistics, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| |
Collapse
|
2
|
Miller-Mikolajczyk C, Beach K, Silverman R, Cooper M. The Evolution of Commercial Negative Pressure Wound Therapy Systems over the Past Three Decades. Adv Wound Care (New Rochelle) 2024; 13:375-390. [PMID: 38666695 DOI: 10.1089/wound.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Significance: Since the introduction of the first commercial negative pressure wound therapy (NPWT) system nearly three decades ago, several key technological innovations have led to the wide adoption of the therapy. This is a review of the history and innovation of commercial NPWT systems for adjunctive management of open wounds. Recent Advances: Technical modifications have broadened NPWT options to include innovative dressing interfaces, tubing configurations, power sources, capability of topical wound solution instillation or irrigation, canister versus canister-free configurations, smart technology, and disposable versus larger reusable therapy units. While these options complicate product selection, they have greatly expanded the potential to manage a wide variety of wounds in patients who previously may not have been candidates for NPWT. Critical Issues: Basic yet mandatory requirements of NPWT include delivering an accurate level of negative pressure to the wound bed, maintaining a seal, removing wound surface exudate through the dressing interface, and patient adherence to prescribed therapy. Meeting these requirements is challenging in the face of variable wound types, wound locations, exudate levels, and exudate viscosity. While there are a growing number of marketed NPWT systems, each may have different characteristics and performance. Evaluating the functionality of each system and relevant accessories is complicated, especially as additional manufacturers enter the market. Understanding the key innovations and specific challenges they are intended to solve may aid health care providers in selecting appropriate NPWT technologies for patients. Future Directions: Evolving technology, including artificial intelligence, will likely play a major role in redefining NPWT safety, simplicity, and reliability.
Collapse
Affiliation(s)
| | | | - Ronald Silverman
- Becton Dickinson and Company, Franklin, New Jersey, USA
- University of Maryland Medical System, Baltimore, Maryland, USA
| | | |
Collapse
|
3
|
Mo PC, Lin CF, Li Y, Hernandez ME, Liao JC, Hung IYJ, Jan YK. Application of near-infrared spectroscopy to assess the effect of the cupping size on the spatial hemodynamic response from the area inside and outside the cup of the biceps. PLoS One 2024; 19:e0302828. [PMID: 38722930 PMCID: PMC11081366 DOI: 10.1371/journal.pone.0302828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/10/2024] [Indexed: 05/13/2024] Open
Abstract
Cupping therapy is a popular intervention for improving muscle recovery after exercise although clinical evidence is weak. Previous studies demonstrated that cupping therapy may improve microcirculation of the soft tissue to accelerate tissue healing. However, it is unclear whether the cupping size could affect the spatial hemodynamic response of the treated muscle. The objective of this study was to use 8-channel near-infrared spectroscopy to assess this clinical question by assessing the effect of 3 cupping sizes (35, 40, and 45 mm in inner diameter of the circular cup) under -300 mmHg for 5 min on the muscle hemodynamic response from the area inside and outside the cup, including oxyhemoglobin and deoxy-hemoglobin in 18 healthy adults. Two-way factorial design was used to assess the interaction between the cupping size (35, 40, and 45 mm) and the location (inside and outside the cup) and the main effects of the cupping size and the location. The two-way repeated measures ANOVA demonstrated an interaction between the cupping size and the location in deoxy-hemoglobin (P = 0.039) but no interaction in oxyhemoglobin (P = 0.100), and a main effect of the cup size (P = 0.001) and location (P = 0.023) factors in oxyhemoglobin. For the cupping size factor, the 45-mm cup resulted in a significant increase in oxyhemoglobin (5.738±0.760 μM) compared to the 40-mm (2.095±0.312 μM, P<0.001) and 35-mm (3.134±0.515 μM, P<0.01) cup. Our findings demonstrate that the cupping size and location factors affect the muscle hemodynamic response, and the use of multi-channel near-infrared spectroscopy may help understand benefits of cupping therapy on managing musculoskeletal impairment.
Collapse
Affiliation(s)
- Pu-Chun Mo
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Yameng Li
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Manuel E. Hernandez
- Department of Biomedical and Translational Science, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Jen-Chieh Liao
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Department of Neurosurgery, Chi Mei Hospital Chiali, Tainan, Taiwan
| | - Isabella Yu-Ju Hung
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| |
Collapse
|
4
|
Chang L, Du H, Xu F, Xu C, Liu H. Hydrogel-enabled mechanically active wound dressings. Trends Biotechnol 2024; 42:31-42. [PMID: 37453911 DOI: 10.1016/j.tibtech.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Wound care is a major clinical and social concern. However, effective wound repair remains challenging where conventional dressings yield detrimental healing outcomes. An emerging technique, named mechanically active dressing (MAD), uses self-contractile hydrogels to mechanically contract the wound bed. MAD has shown improved healing rates with limited side effects. These promising developments in wound care call for a timely review on the development of such technology. Herein, we shed light on the mechanism underlying mechanically modulated wound healing, carry out a systematic discussion on the status quo of designing hydrogels for MAD fabrication, and conclude with perspectives on design, use and clinical translation for realizing the future goal of personalized wound care.
Collapse
Affiliation(s)
- Le Chang
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, Xi'an 710068, China; Shaanxi Engineering Research Center of Cell Immunology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Huicong Du
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Xi'an Jiaotong University, Xi'an 710049, China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, China; Department of Aesthetic, Plastic and Maxillofacial Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710049, China
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Xi'an Jiaotong University, Xi'an 710049, China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, China
| | - Cuixiang Xu
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Shaanxi Provincial People's Hospital, Xi'an 710068, China; Shaanxi Engineering Research Center of Cell Immunology, Shaanxi Provincial People's Hospital, Xi'an 710068, China.
| | - Hao Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Xi'an Jiaotong University, Xi'an 710049, China; Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an 710049, China.
| |
Collapse
|
5
|
Yamashiro T, Kushibiki T, Mayumi Y, Tsuchiya M, Ishihara M, Azuma R. Negative-Pressure Wound Therapy: What We Know and What We Need to Know. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1436:131-152. [PMID: 36922487 DOI: 10.1007/5584_2023_773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Negative-pressure wound therapy (NPWT) promotes wound healing by applying negative pressure to the wound surface. A quarter of a century after its introduction, NPWT has been used in various clinical conditions, although molecular biological evidence is insufficient due to delay in basic research. Here, we have summarized the history of NPWT, its mechanism of action, what is currently known about it, and what is expected to be known in the future. Particularly, attention has shifted from the four main mechanisms of NPWT to the accompanying secondary effects, such as effects on various cells, bacteria, and surgical wounds. This chapter will help the reader to understand the current status and shortcomings of NPWT-related research, which could aid in the development of basic research and, eventually, clinical use with stronger scientific evidence.
Collapse
Affiliation(s)
- Toshifumi Yamashiro
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Yoshine Mayumi
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masato Tsuchiya
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Miya Ishihara
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|
6
|
Gefen A. The influence zone: a critical performance measure for negative pressure wound therapy systems. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S12. [PMID: 35980923 DOI: 10.12968/bjon.2022.31.15.s8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article provides an introduction to the theory of, what is termed, the 'influence zone' in the context of negative pressure wound therapy (NPWT). It is a quantitative bioengineering performance measure for NPWT systems, to indicate their effectiveness, namely, how far from the wound bed edges a specific system is able to deliver effective mechano-stimulation into the periwound, and at which intensity. The influence zone therefore provides objective and standardised metrics of one of the fundamental modes of action of NPWT systems: the ability to effectively and optimally deform both the wound and periwound macroscopically and microscopically. Most important is the mechanical deformation of the periwound area to activate cells responsible for tissue repair, particularly (myo)fibroblasts. Notably, the influence zone must extend sufficiently into the periwound to stimulate (myo)fibroblasts in order that they migrate and progress the wound healing process, facilitating the formation of scar tissue, without overstretching the periwound tissues so as not cause or escalate further cell and tissue damage. The inclusion of the influence zone theory within research to investigate the efficacy of NPWT systems facilitates systematic comparisons of commercially available and potentially new systems. This approach has the capacity to guide not only research and development work, but also clinical decision-making. Recently published research found that inducing an effective influence zone first and foremost requires continuous delivery of the intended pressure to the wound bed.
Collapse
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| |
Collapse
|
7
|
Zeybek B, Li S, Silberschmidt VV, Liu Y. Wound contraction under negative pressure therapy measured with digital image correlation and finite-element analysis in tissue phantoms and wound models. Med Eng Phys 2021; 98:104-114. [PMID: 34848029 DOI: 10.1016/j.medengphy.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to demonstrate the capabilities of finite-element (FE) models to predict contraction of wounds managed with negative pressure wound therapy (NPWT). The features of wounds and surrounding tissues were analysed to gain insights into the mechanical effects of NPWT on them. 3D digital image correlation (DIC) measurement of soft tissue phantoms was used to investigate the effect of wound thickness, size, and shape, which were further compared with results of FE simulations. It was noticed that with an increased NP level the difference between DIC and FE in wound contraction became more pronounced, particularly for the thick wounds. In addition, the locations of the wounds were evaluated to predict their contraction characteristics, based on surrounding tissue structures, in 3D using the developed FE models. It was demonstrated that features and location of wounds influenced their deformations differently for the same pressure levels. Overall, this study, involving a combined experimental and computational approach, allowed the important insights into mechanical effects of NPWT.
Collapse
Affiliation(s)
- Begum Zeybek
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom
| | - Simin Li
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom
| | - Vadim V Silberschmidt
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom
| | - Yang Liu
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, United Kingdom; Centre of Biological Engineering, Loughborough University, United Kingdom.
| |
Collapse
|
8
|
Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J 2021; 19:692-704. [PMID: 34382331 PMCID: PMC8874092 DOI: 10.1111/iwj.13667] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022] Open
Abstract
In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
Collapse
Affiliation(s)
- Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - David M Brienza
- Departments of Rehabilitation Science and Technology & Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Haesler
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Australian National University, Canberra, ACT, Australia
| | - Jan Kottner
- Charité Center 1 for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|