1
|
Ghanbari M, Salkovskiy Y, Carlson MA. The rat as an animal model in chronic wound research: An update. Life Sci 2024; 351:122783. [PMID: 38848945 DOI: 10.1016/j.lfs.2024.122783] [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] [Received: 01/10/2024] [Revised: 03/29/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
The increasing global prevalence of chronic wounds underscores the growing importance of developing effective animal models for their study. This review offers a critical evaluation of the strengths and limitations of rat models frequently employed in chronic wound research and proposes potential improvements. It explores these models in the context of key comorbidities, including diabetes, venous and arterial insufficiency, pressure-induced blood flow obstruction, and infections. Additionally, the review examines important wound factors including age, sex, smoking, and the impact of anesthetic and analgesic drugs, acknowledging their substantial effects on research outcomes. A thorough understanding of these variables is crucial for refining animal models and can provide valuable insights for future research endeavors.
Collapse
Affiliation(s)
- Mahboubeh Ghanbari
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Yury Salkovskiy
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.
| | - Mark A Carlson
- Department of Surgery, Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA.
| |
Collapse
|
2
|
Lee H, Choi S. Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review. BMC Nurs 2024; 23:403. [PMID: 38886734 PMCID: PMC11181566 DOI: 10.1186/s12912-024-02080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients. METHODS The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines. RESULTS Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1-96.7% before intervention to 0.3-53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates. CONCLUSIONS In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness. TRIAL REGISTRATION The review protocol was registered (PROSPERO registration number: CRD42022346450).
Collapse
Affiliation(s)
- Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul, 06974, South Korea
| | - Seunghye Choi
- College of Nursing, Gachon University, 191, Hambangmoe-ro, Yeonsu-gu, Incheon, 21936, South Korea.
| |
Collapse
|
3
|
Sargent M, Wark AW, Day S, Buis A. An ex vivo animal model to study the effect of transverse mechanical loading on skeletal muscle. Commun Biol 2024; 7:302. [PMID: 38461200 PMCID: PMC10925026 DOI: 10.1038/s42003-024-05994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/29/2024] [Indexed: 03/11/2024] Open
Abstract
In many populations like wheelchair and prosthetic users, the soft tissue is subject to excessive or repetitive loading, making it prone to Deep Tissue Injury (DTI). To study the skeletal muscle response to physical stress, numerous in vitro and in vivo models exist. Yet, accuracy, variability, and ethical considerations pose significant trade-offs. Here, we present an ex vivo approach to address these limitations and offer additional quantitative information on cellular damage. In this study, skeletal muscle tissue from Sprague Dawley rats was isolated and transversely loaded. Histological analysis and fluorescence staining demonstrated that the setup was suitable to keep the tissue alive throughout the experimental procedure. Mechanically induced cell damage was readily distinguishable through morphological changes and uptake of a membrane impermeable dye. Our comparably simple experimental setup can be adapted to different loading conditions and tissues to assess the cell response to mechanical loading in future studies.
Collapse
Affiliation(s)
- Marisa Sargent
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Alastair W Wark
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow, United Kingdom
| | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Arjan Buis
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom.
| |
Collapse
|
4
|
Rayward L, Pearcy M, Kerr G, Pivonka P, Little JP. Engineering the perfect mattress: The influence of substrate mechanics on deep tissue stresses in supine. Clin Biomech (Bristol, Avon) 2023; 110:106130. [PMID: 37897845 DOI: 10.1016/j.clinbiomech.2023.106130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND With increasing global interest in sleep hygiene, sleep ergonomics is an area that has been largely understudied. During sleep individuals turn over during the night to restore blood flow in occluded blood vessels, indicating that control of local tissue pressure may play a role in improving sleep comfort. This study investigates the influence of mattress stiffness on tissue compressive stresses during supine lying. METHODS A subject-specific 3D finite element (FE) model of the pelvis area has been developed to simulate supine lying on substrates of varying firmness. Constitutive parameters for the adipose-skin tissue and muscle-organ tissue were calibrated using a novel application of the inverse finite element method. FINDINGS The compressive stress was consistently greatest in the muscle interfacing the sacrum at 18.5 kPa on the soft foam, and 30.9 kPa on the firm foam. From soft to firm, the compressive stress increased by 67% at the sacrum, 20% at the ischium, 42% at the lesser trochanter, and 50% at the skin. INTERPRETATION The non-linearity of the foam substrate had a pressure distributing effect, relieving the peak compressive stresses at the sacrum, indicating that it may be possible to design arrays of foam substrates that can provide most efficient pressure relief.
Collapse
Affiliation(s)
- Lionel Rayward
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies, Queensland University of Technology, Australia.
| | - Mark Pearcy
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies, Queensland University of Technology, Australia
| | - Graham Kerr
- School of Exercise & Nutrition Sciences, Faculty of Healthy, Queensland University of Technology, Australia
| | - Peter Pivonka
- Faculty of Engineering, School of Mech., Medical & Process Engineering, Queensland University of Technology, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group, Centre for Biomedical Technologies, Queensland University of Technology, Australia
| |
Collapse
|
5
|
Osuagwu B, McCaughey E, Purcell M. A pressure monitoring approach for pressure ulcer prevention. BMC Biomed Eng 2023; 5:8. [PMID: 37563686 PMCID: PMC10416505 DOI: 10.1186/s42490-023-00074-6] [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: 03/12/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND A pressure ulcer (PU) is a debilitating condition that disproportionately affects people with impaired mobility. PUs facilitate tissue damage due to prolonged unrelieved pressure, degrading quality of life with a considerable socio-economic impact. While rapid treatment is crucial, an effective prevention strategy may help avoid the development of PUs altogether. While pressure monitoring is currently used in PU prevention, available monitoring approaches are not formalised and do not appropriately account for accumulation and relief of the effect of an applied pressure over a prolonged duration. The aim of this study was to define an approach that incorporates the accumulation and relief of an applied load to enable continuous pressure monitoring. RESULTS A tunable continuous pressure magnitude and duration monitoring approach that can account for accumulated damaging effect of an applied pressure and pressure relief over a prolonged period is proposed. Unlike classic pressure monitoring approaches, the presented method provides ongoing indication of the net impact of a load during and after loading. CONCLUSIONS The tunable continuous pressure magnitude and duration monitoring approach proposed here may further development towards formalised pressure monitoring approaches that aim to provide information on the risk of PU formation in real-time.
Collapse
Affiliation(s)
- Bethel Osuagwu
- Biomedical Engineering Research Division, School of Engineering, University of Glasgow, Glasgow, UK.
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Euan McCaughey
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, G51 4TF, Scotland
- Neuroscience Research Australia, Sydney, Australia
| | - Mariel Purcell
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, G51 4TF, Scotland
| |
Collapse
|
6
|
Trebbi A, Fougeron N, Payan Y. Definition and evaluation of a finite element model of the human heel for diabetic foot ulcer prevention under shearing loads. Med Eng Phys 2023; 118:104022. [PMID: 37536842 DOI: 10.1016/j.medengphy.2023.104022] [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] [Received: 05/14/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
Diabetic foot ulcers are triggered by mechanical loadings applied to the surface of the plantar skin. Strain is considered to play a crucial role in relation to ulcer etiology and can be assessed by Finite Element (FE) modeling. A difficulty in the generation of these models is the choice of the soft tissue material properties. In the literature, many studies attempt to model the behavior of the heel soft tissues by implementing constitutive laws that can differ significantly in terms of mechanical response. Moreover, current FE models lack of proper evaluation techniques that could estimate their ability to simulate realistic strains. In this article, we propose and evaluate a FE model of the human heel for diabetic foot ulcer prevention. Soft tissue constitutive laws are defined through the fitting of experimental stretch-stress curves published in the literature. The model is then evaluated through Digital Volume Correlation (DVC) based on non-rigid 3D Magnetic Resonance Image Registration. The results from FE analysis and DVC show similar strain locations in the fat pad and strain intensities according to the type of applied loads. For additional comparisons, different sets of constitutive models published in the literature are applied into the proposed FE mesh and simulated with the same boundary conditions. In this case, the results in terms of strains show great diversity in locations and intensities, suggesting that more research should be developed to gain insight into the mechanical properties of these tissues.
Collapse
Affiliation(s)
- Alessio Trebbi
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France.
| | - Nolwenn Fougeron
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Yohan Payan
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| |
Collapse
|
7
|
Jia J, Gong S, Zhang A, Jiang L, Yao Y. Stiffening of the gluteal muscle increased the intramuscular stress: An in-silico implication of deep tissue injury. Heliyon 2023; 9:e13459. [PMID: 36816309 PMCID: PMC9929311 DOI: 10.1016/j.heliyon.2023.e13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives Deep tissue injury is a common form of pressure ulcers in muscle tissues under bony prominences caused by sustained pressure or shear, which has a great impact on patients with restricted mobility such as spinal cord injury. Frequent spasms in spinal cord injury patients featured by muscle stiffening may be one of the factors leading to deep tissue injury. The purpose of this study was to investigate the relationship between the gluteal muscle shear modulus and intramuscular compressive/shear stress/strain. Methods A semi-3D finite element model of the human buttock was established using COMSOL software and the acquired biomechanical data were analyzed through Pearson correlation and Spearman correlation. Results Results showed that the compressive stress, strain energy density, and average von Mises stress increased with the increase of the gluteal muscle shear modulus. Conclusion These results may indicate muscle stiffening caused by muscle spasms could lead to higher deep tissue injury development risk as well as shed light on effective treatments for relieving muscular sclerosis mechanically.
Collapse
Affiliation(s)
- Jingyi Jia
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 1954 Huashan Road, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shengbo Gong
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 1954 Huashan Road, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Aili Zhang
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Liping Jiang
- Nursing Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yifei Yao
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 1954 Huashan Road, Shanghai Jiao Tong University, Shanghai 200030, China,Corresponding author. School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China.
| |
Collapse
|
8
|
Chatzistergos P, E Scott T, Thorburn M, Chockalingam N. Understanding occipital pressure sores in UK military casualties: a pilot study in healthy military personnel. BMJ Mil Health 2023:e002305. [PMID: 36725104 DOI: 10.1136/military-2022-002305] [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: 10/31/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The high prevalence of occipital ulcers in UK military casualties observed during the conflict in Afghanistan is a multifactorial phenomenon. However, the consensus is that ulceration is triggered by excessive pressure that is maintained for too long during the use of the general service military stretcher. Thresholds for capillary occlusion are accepted benchmarks to define excessive pressure, but similar thresholds for safe/excessive duration of pressure application do not exist. To address this gap in knowledge, we propose to use the time it takes for a healthy person to feel pain at the back of the head as an initial indication of safe exposure to pressure. METHODS Healthy military personnel (16 male/10 female) were asked to lie motionless on a typical general service stretcher until they felt pain. Time-to-pain and the location of pain were recorded. To support the interpretation of results, baseline sensitivity to pain and pressure distribution at the back of the head were also measured. Independent samples t-test was used to assess differences between genders. RESULTS Twenty participants felt pressure-induced soft-tissue pain at the back of the head. The remaining six participants terminated the test due to musculoskeletal pain caused by poor ergonomic positioning. On average, pain at the occiput developed after 31 min (±14 min). Female participants were significantly more sensitive to pain (t(24)=3.038,p=0.006), but time-to-pain did not differ significantly between genders (p>0.05). CONCLUSIONS When people lie motionless on a typical military stretcher, the back of the head is the first area of the body that becomes painful due to pressure. The fact that pain develops in ≈30 min can help healthcare providers decide how frequently to reposition their patients who are unable to do this on their own. More research is still needed to directly link time-to-pain with time-to-injury.
Collapse
Affiliation(s)
- Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - T E Scott
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Intensive Care Unit, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - M Thorburn
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - N Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Faculty of Health Sciences, University of Malta, Msida, Malta
| |
Collapse
|
9
|
Long-Term Aesthetic and Functional Evaluation of Intramuscular Augmentation Gluteoplasty with Implants. Plast Reconstr Surg 2023; 151:40e-46e. [PMID: 36205700 DOI: 10.1097/prs.0000000000009792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The insertion of gluteal silicone implants by intramuscular technique leads patients to develop gluteus maximus muscle atrophy. The objective of the present study was to correlate the muscular atrophy of the gluteus maximus proportional to the volume of the silicone implants used. The secondary objectives were to assess volumetry of the gluteus maximus muscle in the late follow-up, to assess the positioning of the implants, and to verify the association between volumetric muscle recovery and practice of physical exercise. METHODS This is a prospective study. The sample was composed of 22 patients who were operated and followed up on an outpatient basis and through gluteus computed tomography at three different moments: preoperatively, 12 months postoperatively, and late postoperatively (≥96 months). RESULTS Computed tomographic three-dimensional reconstruction and volumetric analysis showed a median atrophy of 6.68% of the gluteus maximus muscle volume in 12 months and 7.47% in the late postoperative period. The correlation between relative volume of the implant and atrophy percentage of the gluteus maximus did not present statistically significant results. There was an association between the practice of physical exercise and volumetry recovery of the gluteus maximus. No patient presented gluteal implant rotation. CONCLUSIONS There is no correlation between proportional volume of implants and atrophy percentage of gluteus maximus muscle, when using implants up to 400 cm 3 . The gluteus maximus muscle presents atrophy in the late follow-up of augmentation gluteoplasty with implants. There is recovery of muscle volumetry in the patients who practice physical activities. Intramuscular plane implants demonstrated stability in their long-term positioning. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
10
|
Factors Associated with Pressure Injury Among Critically Ill Patients in a Coronary Care Unit. Adv Skin Wound Care 2022; 35:1-10. [PMID: 36125458 DOI: 10.1097/01.asw.0000872172.83299.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To ascertain the incidence of pressure injuries (PIs) in patients in the coronary care unit (CCU), identify PI characteristics, and determine associated risk factors. METHODS Researchers conducted a retrospective investigational study of patients' medical records. A total of 820 patients who were admitted to the CCU between January 2018 and December 2020 met the study criteria. Of these, 200 patients who developed PIs after admission to the CCU were included in this study. This study examined the clinical features of PIs, as well as five PI risk factors: patient characteristics; length of stay; intrinsic factors; care factors, including medical devices; and vasopressor agents. RESULTS The incidence of PIs among patients in the CCU was 24.4%. At initial detection, 79.5% of these injuries were already at stage 2 or higher. The results indicated a significant correlation between PI stage and hemoglobin level. Moreover, the authors also found relationships between the use of medical devices (eg, arterial catheters, oxygen tubes, and Levin tubes) and PI onset. CONCLUSIONS Critically ill patients in the CCU use various medical devices for an extended period with severe consequences. The risk factors affecting PI are multifactorial. Therefore, the implementation of PI prevention and early detection strategies for patients in the CCU are crucial.
Collapse
|
11
|
Mechanical analysis of deep tissue injury during sitting in patients with spinal cord injury via parametric finite element model. Biomech Model Mechanobiol 2022; 21:1573-1584. [PMID: 35931860 DOI: 10.1007/s10237-022-01607-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022]
Abstract
Spinal cord injury patients are prone to develop deep tissue injury because of long-term mechanical load. However, there is a lack of statistical research on the influence of tissue characteristics on the internal mechanical state of soft tissue. This study aimed to investigate the influence of tissue characteristics on the internal mechanical state of buttock in spinal cord injury patients. A three-dimensional reference buttock model was established and a visualization program was generated to modify the parameter values. Through changing the muscle atrophy, body mass index and the radius of curvature of the ischial tuberosity, 96 different model variants were simulated and validated in this study. With body mass index increasing from 16 to 40, the principal shear stress was 10.4 times principal compressive stress, the maximum shear strain and the max cluster volume increased by 1.2 (P < 0.001) and 8.8 times (P < 0.001), respectively. The interaction between BMI and muscle atrophy was significant when BMI was greater than or equal to 22.5 kg/m2. In all BMI stages, when the radius of curvature of the ischial tuberosity was 19 mm, the internal stress of the tissue always occupies the highest value. The results demonstrate that body mass index is the most important factor affecting the risk of buttock deep tissue injury. This study provides insights into investigation of inter-individual factors influencing the soft tissue response and assessment of deep tissue injury risk during sitting.
Collapse
|
12
|
Langemo D, Anderson J, Hanson D, Thompson P, Johnson E. The Conundrum of Turning/Repositioning Frequency, Sleep Surface Selection, and Sleep Disruption in Preventing Pressure Injury in Healthcare Settings. Adv Skin Wound Care 2022; 35:252-259. [PMID: 35442917 DOI: 10.1097/01.asw.0000824780.10098.d1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing and Professional Development, University of North Dakota, Grand Forks, United States. Julie Anderson, PhD, RN, is Dean, Winona State University, Minnesota. Also at the University of North Dakota, Darlene Hanson, PhD, RN, is Clinical Professor, College of Nursing and Professional Development; Patricia Thompson, MS, RN, is Clinical Assistant Professor, College of Nursing and Professional Development; and Erika Johnson, MLIS, is Clinical Campus Librarian, School of Medicine and Health Sciences. Submitted June 8, 2021; accepted in revised form October 20, 2021
| | | | | | | | | |
Collapse
|
13
|
Rayward L, Little JP. A subject-specific FEM to predict deep tissue mechanical stresses when supine: Development of efficient contact interfaces using Shared Topology. J Biomech 2022; 137:111085. [DOI: 10.1016/j.jbiomech.2022.111085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
|
14
|
Lavigne T, Sciumè G, Laporte S, Pillet H, Urcun S, Wheatley B, Rohan PY. Société de Biomécanique Young Investigator Award 2021: Numerical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2022; 93:105592. [PMID: 35151107 DOI: 10.1016/j.clinbiomech.2022.105592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pressure-induced tissue strain is one major pathway for Pressure Ulcer development and, especially, Deep Tissue Injury. Biomechanical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue is therefore essential. In the literature, a viscoelastic formulation is generally assumed for the experimental characterization of skeletal muscles, with the limitation that the underlying physical mechanisms that give rise to the time dependent stress-strain behaviour are not known. The objective of this study is to explore the capability of poroelasticity to reproduce the apparent viscoelastic behaviour of passive muscle tissue under confined compression. METHODS Experimental stress-relaxation response of 31 cylindrical porcine samples tested under fast and slow confined compression by Vaidya and collaborators were used. An axisymmetric Finite Element model was developed in ABAQUS and, for each sample a one-to-one inverse analysis was performed to calibrate the specimen-specific constitutive parameters, namely, the drained Young's modulus, the void ratio, hydraulic permeability, the Poisson's ratio, the solid grain's and fluid's bulk moduli. FINDINGS The peak stress and consolidation were recovered for most of the samples (N=25) by the poroelastic model (normalised root-mean-square error ≤0.03 for fast and slow confined compression conditions). INTERPRETATION The strength of the proposed model is its fewer number of variables (N=6 for the proposed poroelastic model versus N=18 for the viscohyperelastic model proposed by Vaidya and collaborators). The incorporation of poroelasticity to clinical models of Pessure Ulcer formation could lead to more precise and mechanistic explorations of soft tissue injury risk factors.
Collapse
Affiliation(s)
- T Lavigne
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France; Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France.
| | - G Sciumè
- Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France
| | - S Laporte
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| | - H Pillet
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| | - S Urcun
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France; Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France; Institute for Computational Engineering Sciences, Department of Engineering Sciences, Faculte des Sciences, de la Technologie et de Medecine, Universite du Luxembourg, Campus Kirchberg, 6, rue Coudenhove-Kalergi, Luxembourg, L-1359, Luxembourg
| | - B Wheatley
- Department of Mechanical Engineering, Bucknell University, 1 Dent Drive, Lewisburg 17837, PA, USA
| | - P-Y Rohan
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| |
Collapse
|
15
|
Öğülmüş Demircan F, Yücedağ İ, Toz M. A novel mathematical model including the wetness parameter as a variable for prevention of pressure ulcers. Proc Inst Mech Eng H 2021; 236:427-437. [PMID: 34696655 DOI: 10.1177/09544119211048557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pressure ulcers are injuries caused by external conditions such as pressure, friction, shear, and humidity resulting from staying in the same position for a long time in bedridden patients. It is a serious problem worldwide when assessed in terms of hospital capacity, nursing staff employment and treatment costs. In this study, we developed a novel mathematical model based on one of our previous models to prevent pressure ulcers or delay injuries. The proposed model uses a human thermal model that includes skin temperature, hypothalamus temperature, regional perspiration coefficient, and unconsciously loss of water amount. Moreover, in our model, we defined a variable wetness parameter in addition to the parameters, pressure, temperature, and humidity. The proposed model is mathematically defined in detail and tested for a wide range of parameters to show the model's effectiveness in determining the pressure ulcer formation risk. The model is also compared with a model from the literature that based on only the general parameters, pressure, temperature, and humidity. The obtained results showed that the model determines the risk of the occurrence of the pressure ulcer more precisely than the compared one.
Collapse
Affiliation(s)
| | - İbrahim Yücedağ
- Department of Computer Engineering, Faculty of Engineering, Duzce University, Duzce, Turkey
| | - Metin Toz
- Department of Computer Engineering, Faculty of Engineering, Karamanoglu Mehmetbey University, Karaman, Turkey
| |
Collapse
|
16
|
Shifting loads as a result of chair articulations and associated perfusion responses in the context of pressure injuries: An investigation with able-bodied individuals. J Tissue Viability 2021; 31:104-111. [PMID: 34649764 DOI: 10.1016/j.jtv.2021.10.001] [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: 05/06/2021] [Revised: 07/22/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
Wheelchair users with spinal cord injuries experience pressure injuries at high rates, causing a decrease in quality of life and an increased financial burden. The soft tissue in the buttocks (beneath the ischial tuberosities) and lower back (behind the sacrum) experience large interface pressures over long periods while seated, putting them at high risk of pressure injury development. The goals of this research were to evaluate the ability of an articulating chair design to redistribute pressures on the body and to affect blood perfusion in the buttocks tissue over the ischial tuberosities. Using a unique, custom-designed chair developed for this research, pressure and blood perfusion were obtained for numerous seated positions that included recline, seat pan tilt, and back articulations. Reclining the chair back increased maximum pressures in the buttocks and lower back regions, while it decreased maximum pressures in the upper back and thigh regions. Increasing seat pan tilt, or rotating the anterior edge of the seat pan above the posterior edge, decreased maximum pressures in the buttocks and lower back regions and increased perfusion in the buttocks. Results suggested that using back recline and seat pan tilt together to create a whole-body tilt increased pressures in the back and decreased pressures in the buttocks. Changes in back articulation redistributed pressure in all back regions. Thus, the articulating chair design redistributed pressures in all areas of the body and promoted blood perfusion in the buttocks while seated. Pressure redistribution and perfusion promotion are fundamental to reducing pressure injury risk.
Collapse
|
17
|
A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler's Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199992. [PMID: 34639293 PMCID: PMC8507824 DOI: 10.3390/ijerph18199992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022]
Abstract
Insufficient research exists for position change intervals to eradicate pressure ulcers. We tried to provide evidence for the position change interval by comparing peak pressure, risk area ratio, and the time to reach 30 mmHg and 60 mmHg, and presented this in detail, according to the angle in the three positions. The study conducted RCTs on a total of 64 healthy adults. For two hours, interface pressure measurements were compared with 30° and 90° tilting at the inclined, 0° and 45° head-of-bed (HOB) elevation at the supine, and 30° and 45° HOB elevation at the Fowler’s position. The peak pressure on 30° tilting remained less than 60 mmHg for 2 h, unlike 90° tilting. To reach 60 mmHg took 78.18 min at 30° tilting, within 30 min at the 30° supine, 30° and 45° at the Fowler’s position, and 39.55 min at 0° supine. The pressure difference according to the angles was only significant at 30° and 90° tilting, with no difference in the other groups. To prevent pressure ulcers, position changes are required every 2 h in the 30° tilting position, every 1.5 to 2 h at 0° supine, and at least every 1.5 h for all the other positions.
Collapse
|
18
|
Nuchprayoon N, Ritruechai P, Watchararat K, Limroongruengrat W, Wongtawan T, Arya N. Equine spinal kinematics derived from different riding positions during asymmetrical bareback riding. J Equine Sci 2021; 32:81-89. [PMID: 34539209 PMCID: PMC8437752 DOI: 10.1294/jes.32.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Hippotherapy in patients with neuromuscular dysfunction creates high focal pressure on
the pony’s back due to bareback riding and an asymmetrical riding position. This study
aimed to investigate the acute effect of asymmetrical bareback riding on the pony’s spinal
kinematics, blood lactate, serum creatine kinase, heart rate, and temperament score. Eight
ponies were selected, and they were walked on a treadmill for 45 min on each experimental
day, including warm-up (5 min), weight-loading by mannequin (30 min), and cool-down (10
min) sessions. During the weight-loading session, three different weight distributions on
the pony’s back were applied between the left and right side: 50:50 (treatment M), 70:30
(treatment L), and 30:70 (treatment R) on the first, second, and third day of the
experiment, respectively. The spinal kinematics at the end of the weight-loading session
revealed a slight reduction in range of motion in both flexion-extension and lateral
bending during treatment R. Stride length and stride duration showed no differences
between treatments. The levels of blood lactate and serum creatine kinase and results of a
back examination were normal. Heart rates and temperament scores revealed that all ponies
were calm throughout loading of the mannequin. This information suggests that asymmetrical
bareback riding did not cause acute or serious back injury, which indicates good equine
welfare in ponies used for hippotherapy.
Collapse
Affiliation(s)
- Nuttawut Nuchprayoon
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Pattama Ritruechai
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Krisana Watchararat
- Equine Clinic, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand
| | | | - Tuempong Wongtawan
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80161, Thailand
| | - Nlin Arya
- Department of Pre-clinic and Applied Animal Science, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand
| |
Collapse
|
19
|
Scott J, Bush TR. Key Components Related to Pressure Injury Formation: An Initial Investigation Into Pressure Distribution and Blood Perfusion Responses in Wheelchair Users. J Biomech Eng 2021; 143:1114964. [PMID: 34308952 DOI: 10.1115/1.4051888] [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: 02/25/2021] [Indexed: 11/08/2022]
Abstract
Soft tissue around bony prominences in the buttocks and back are high-risk areas prone to the development of pressure injuries. From a clinical perspective, prevention of pressure injuries all together is the ideal situation. Unfortunately, prevalence rates still reach 47% with recurrence rates even higher. The goals of this study were to evaluate the effects of a series of wheelchair movements, some that currently exist in commercial wheelchairs and some new, on interface pressures and perfusion under the buttocks. Twenty-seven chair positions were obtained by varying back recline, seat pan tilt, and articulation of two supports along the back. Although back recline is commonly taught by therapists to be used as a pressure relieving posture, results indicated an increase in pressures under the ischial tuberosities and sacral areas in reclined positions. Articulation of the back supports produced changes in posture moving from an "erect" to "slouched" position. These movements successfully shifted pressures across back regions. Seat pan tilt was effective in shifting pressures off the ischial tuberosity regions. Additionally, in a portion of the participants, seat pan tilt consistently increased perfusion under the ischial tuberosity region. The findings of this research suggest that movements other than back recline should be considered to more effectively alter interface pressures, particularly in high-risk regions like the sacrum and ischial tuberosities.
Collapse
Affiliation(s)
- Justin Scott
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, Room 2555, Engineering Building, East Lansing, MI 48824-1226
| | - Tamara Reid Bush
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, Room 2555, Engineering Building, East Lansing, MI 48824-1226
| |
Collapse
|
20
|
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: 82] [Impact Index Per Article: 27.3] [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
|
21
|
Grigatti A, Gefen A. What makes a hydrogel-based dressing advantageous for the prevention of medical device-related pressure ulcers. Int Wound J 2021; 19:515-530. [PMID: 34245120 PMCID: PMC8874119 DOI: 10.1111/iwj.13650] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022] Open
Abstract
The synergistic influences of geometrical, mechanical and thermal mismatches between a skin‐contacting medical device and the skin may cause tissue stress concentrations and sharp temperature gradients, both of which contribute to the risk for medical device‐related pressure ulcers. In this work, we developed an innovative, integrated experimental bioengineering approach encompassing mechanical stiffness, friction and thermal property studies for testing the biomechanical suitability of a hydrogel‐based dressing in prophylaxis of injuries caused by devices. We characterised the viscoelastic stress relaxation of the dressing and determined its long‐term elastic modulus. We further measured the coefficient of friction of the hydrogel‐based dressing at dressing‐device and skin‐dressing interfaces, using a tilting‐table tribometer. Lastly, we measured the thermal conductivity of the dressing, using a heat‐flow meter and infrared thermography‐based method. All measurements considered dry and moist conditions, the latter simulating skin perspiration effects. Our results revealed that the long‐term stiffness and the thermal conductivity of the hydrogel‐based dressing matched the corresponding properties of human skin for both dry and moist conditions. The dressing further demonstrated a relatively high coefficient of friction at its skin‐facing and device‐facing aspects, indicating minimal frictional sliding. All these properties make the above dressing advantageous for prevention of device‐related injuries.
Collapse
Affiliation(s)
- Angela Grigatti
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
22
|
A review of foot finite element modelling for pressure ulcer prevention in bedrest: Current perspectives and future recommendations. J Tissue Viability 2021; 31:73-83. [PMID: 34238649 DOI: 10.1016/j.jtv.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Pressure ulcers (PUs) are a major public health challenge, having a significant impact on healthcare service and patient quality of life. Computational biomechanical modelling has enhanced PU research by facilitating the investigation of pressure responses in subcutaneous tissue and skeletal muscle. Extensive work has been undertaken on PUs on patients in the seated posture, but research into heel ulcers has been relatively neglected. The aim of this review was to address the key challenges that exist in developing an effective FE foot model for PU prevention and the confusion surrounding the wide range of outputs reported. Nine FE foot studies investigating heel ulcers in bedrest were identified and reviewed. Six studies modelled the posterior part of the heel, two included the calf and foot, and one modelled the whole body. Due to the complexity of the foot anatomy, all studies involved simplification or assumptions regarding parts of the foot structure, boundary conditions and material parameters. Simulations aimed to understand better the stresses and strains exhibited in the heel soft tissues of the healthy foot. The biomechanical properties of soft tissue derived from experimental measurements are critical for developing a realistic model and consequently guiding clinical decisions. Yet, little to no validation was reported in each of the studies. If FE models are to address future research questions and clinical applications, then sound verification and validation of these models is required to ensure accurate conclusions and prediction of patient outcomes. Recommendations and considerations for future FE studies are therefore proposed.
Collapse
|
23
|
Stephen CP, Norman ST. Design and development of a biological implant for long term intravaginal retention in cattle. Aust Vet J 2021; 99:326-333. [PMID: 33954984 DOI: 10.1111/avj.13076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Design, develop and trial an intravaginal device able to remain within the bovine vagina for up to 6 months, accommodating various technologies, while not adversely affecting the cow, or pregnancy. METHODS Device scoping required minimal interference with vaginal drainage, no constant pressure on any single point of the vaginal mucosa and minimal footprint on the vaginal floor. A polycarbonate prototype was developed consisting of a central cargo space to house sensors and battery, with a separate retention module. Mathematical modelling informed the required length and flexibility of the arms on the retention module to reduce pressure necrosis and inflammation within the vagina. The prototype was initially trialled, with a loaded cargo pod, for 4 weeks in five non-pregnant cows. Cows were monitored for signs of systemic infection and inflammation by collecting blood samples for haematology and acute phase inflammatory proteins. Cows were also assessed for general demeanour, signs of discomfort and positioning of the device. Later, the device was inserted into 20 early pregnant cows, with 20 contemporary, untreated controls. Cows were monitored, as in the initial trial, every 4 weeks for the next 5 to 6 months until calving. RESULTS In Trial 1, there was 100% retention with no adverse effects. In Trial 2, device retention was 75% until calving with no adverse effects on cow health or pregnancy. CONCLUSIONS We describe the longest successful deployment of an intravaginal device in pregnant and non-pregnant cattle, with long-term retention, no adverse effects and 28 cm3 of cargo space.
Collapse
Affiliation(s)
- C P Stephen
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia
| | - S T Norman
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Kallangur Veterinary Surgery, Kallangur, Queensland, Australia
| |
Collapse
|
24
|
Tissue matters: In-vivo tissue properties of persons with spinal cord injuries to inform clinical models for pressure ulcer prevention. J Biomech 2021; 120:110389. [PMID: 33780812 DOI: 10.1016/j.jbiomech.2021.110389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 01/01/2023]
Abstract
The prevalence of pressure ulcers in patients with spinal cord injuries has been estimated to be between 30% and 47%. Individuals with spinal cord injuries sit for a majority of the time, increasing the risk of developing pressure ulcers in the buttocks and thighs due to large internal stresses. Human body models have been developed to study the formation of pressure ulcers, yet a persistent limitation in these models has been the material properties used to represent the soft tissues in the buttocks and thighs. Specifically, soft tissue material property data have not included wheelchair users, such as those with spinal cord injuries. The goals of this research were 1) to determine the in-vivo material properties of soft tissue in the thighs and buttocks of individuals with spinal cord injuries and 2) compare these to properties obtained from able-bodied people. Results indicated that the proximal and middle thigh regions of those who had a spinal cord injury were softer than the same regions as able-bodied individuals, while the distal thigh regions were stiffer. These findings are vital because they indicate that models developed using properties from able-bodied individuals will not produce internal stress or strain magnitudes that represent individuals who have a spinal cord injury. This information suggests that models should obtain material property data sets from their desired population. Human body models must represent the population being studied if they are to inform clinical assessments and make accurate patient predictions.
Collapse
|
25
|
The mechanobiology theory of the development of medical device-related pressure ulcers revealed through a cell-scale computational modeling framework. Biomech Model Mechanobiol 2021; 20:851-860. [PMID: 33606118 PMCID: PMC7893381 DOI: 10.1007/s10237-021-01432-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
Pressure ulcers are localized sites of tissue damage which form due to the continuous exposure of skin and underlying soft tissues to sustained mechanical loading, by bodyweight forces or because a body site is in prolonged contact with an interfacing object. The latter is the common cause for the specific sub-class of pressure ulcers termed ‘medical device-related pressure ulcers’, where the injury is known to have been caused by a medical device applied for a diagnostic or therapeutic purpose. Etiological research has established three key contributors to pressure ulcer formation, namely direct cell and tissue deformation, inflammatory edema and ischemic damage which are typically activated sequentially to fuel the injury spiral. Here, we visualize and analyze the above etiological mechanism using a new cell-scale modeling framework. Specifically, we consider here the deformation-inflicted and inflammatory contributors to the damage progression in a medical device-related pressure ulcer scenario, forming under a continuous positive airway pressure ventilation mask at the microarchitecture of the nasal bridge. We demonstrate the detrimental effects of exposure to high-level continuous external strains, which causes deformation-inflicted cell damage almost immediately. This in turn induces localized edema, which exacerbates the cell-scale mechanical loading state and thereby progresses cell damage further in a nonlinear, escalating pattern. The cell-scale quantitative description of the damage cascade provided here is important not only from a basic science perspective, but also for creating awareness among clinicians as well as industry and regulators with regards to the need for improving the design of skin-contacting medical devices.
Collapse
|
26
|
Solmos S, LaFond C, Pohlman AS, Sala J, Mayampurath A. Characteristics of Critically Ill Adults With Sacrococcygeal Unavoidable Hospital-Acquired Pressure Injuries: A Retrospective, Matched, Case-Control Study. J Wound Ostomy Continence Nurs 2021; 48:11-19. [PMID: 33427805 DOI: 10.1097/won.0000000000000721] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To identify characteristics of critically ill adults with sacrococcygeal, unavoidable hospital-acquired pressure injuries (uHAPIs). DESIGN Retrospective, matched, case-control design. SUBJECTS/SETTING Patients admitted to adult intensive care units (ICUs) at an urban academic medical center from January 2014 through July 2016. METHODS Thirty-four patients without uHAPI were matched to 34 patients with sacrococcygeal uHAPI. Time points of interest included admission to the ICU, the week preceding the definitive assessment date, and hospital discharge status. Variables of interest included length of stay, any diagnosis of sepsis, severity of illness, degree of organ dysfunction/failure, supportive therapies in use (eg, mechanical ventilation), and pressure injury risk (Braden Scale score). RESULTS All 34 sacrococcygeal pressure injuries were classified as uHAPI using the pressure injury prevention inventory instrument. No statistically significant differences were noted between patients for severity of illness, degree of organ dysfunction/failure, or pressure injury risk at ICU admission. At 1 day prior to the definitive assessment date and at discharge, patients with uHAPI had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores (greater organ dysfunction/failure) and lower mean Braden Scale scores (greater pressure injury risk) than patients without uHAPI. Patients with uHAPI had significantly longer lengths of stay, more supportive therapies in use, were more often diagnosed with sepsis, and were more likely to die during hospitalization. CONCLUSION Sacrococcygeal uHAPI development was associated with progressive multiorgan dysfunction/failure, greater use of supportive therapies, sepsis diagnosis, and mortality. Additional research investigating the role of multiorgan dysfunction/failure and sepsis on uHAPI development is warranted.
Collapse
Affiliation(s)
- Susan Solmos
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Cynthia LaFond
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Anne S Pohlman
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Jennifer Sala
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| | - Anoop Mayampurath
- Susan Solmos, MSN, RN, CWCN, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois
- Cynthia LaFond, PhD, RN, CCRN-K, Center for Nursing Professional Practice and Research, the University of Chicago Medicine, Chicago, Illinois; Rush University Medical Center, Chicago, Illinois
- Anne S. Pohlman, MSN, RN, CCRN, Section of Pulmonary/Critical Care, Department of Medicine, the University of Chicago, Chicago, Illinois
- Jennifer Sala, ADN, RN, Medical Intensive Care Unit, the University of Chicago Medicine, Chicago, Illinois
- Anoop Mayampurath, PhD, Department of Pediatrics, the University of Chicago, Chicago, Illinois; Center for Research Informatics, the University of Chicago, Chicago, Illinois
| |
Collapse
|
27
|
Mansur R, Peko L, Shabshin N, Cherbinski L, Neeman Z, Gefen A. Ultrasound elastography reveals the relation between body posture and soft-tissue stiffness which is relevant to the etiology of sitting-acquired pressure ulcers. Physiol Meas 2021; 41:124002. [PMID: 33126232 DOI: 10.1088/1361-6579/abc66d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Sitting-acquired pressure ulcers (PUs) are common in wheelchair users. These PUs are often serious and may involve deep tissue injury (DTI). Investigating the mechanical properties of the tissues susceptible to DTI may help in guiding the prevention and early detection of PUs. In this study, shear wave elastography (SWE) was used to measure the normative mechanical properties of the soft tissues of the buttocks, i.e. skeletal muscle and subcutaneous fat, under the ischial tuberosities, in a convenient sample of healthy adults without weight bearing and with weight bearing of different times. APPROACH We compared the stiffness properties of these soft tissues between the lying prone and sitting postures, to determine whether there are detectable property changes that may be associated with the type of posture. We hypothesized that muscle contractions and 3D tissue configurations associated with the posture may influence the measured tissue stiffnesses. MAIN RESULTS Our results have shown that indeed, SWE values differed significantly across postures, but not over time in a specific posture or for the right versus left sides of the body. SIGNIFICANCE We have therefore demonstrated that soft-tissue stiffness increases when sitting with weight bearing and may contribute to increasing the potential PU risk in sitting compared to lying prone, given the stiffer behavior of tissues observed in sitting postures.
Collapse
Affiliation(s)
- Ruba Mansur
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | |
Collapse
|
28
|
Black JM, Berke CT. Deep Tissue Pressure Injuries: Identification, Treatment, and Outcomes Among Critical Care Patients. Crit Care Nurs Clin North Am 2020; 32:563-572. [PMID: 33129414 DOI: 10.1016/j.cnc.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Deep tissue pressure injury (DTPI) is a serious form of pressure injuries. The condition remains invisible for up to 48 hours and then progresses rapidly to full-thickness skin and soft tissue loss. Many other conditions that lead to purple skin can be misidentified as DTPI, making the diagnosis difficult at times. A thorough history exploring exposure to pressure is imperative.
Collapse
Affiliation(s)
- Joyce M Black
- College of Nursing, University of Nebraska Medical Center, Omaha, NE 68198-5330, USA.
| | - Christine T Berke
- Center for Wound Healing and Ostomy Care, Nebraska Medicine, Omaha, NE 68198-1201, USA
| |
Collapse
|
29
|
Scott J, Chen S, Roccabianca S, Bush TR. The effects of body position on the material properties of soft tissue in the human thigh. J Mech Behav Biomed Mater 2020; 110:103964. [DOI: 10.1016/j.jmbbm.2020.103964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
|
30
|
Graser M, Day S, Buis A. Exploring the role of transtibial prosthetic use in deep tissue injury development: a scoping review. BMC Biomed Eng 2020; 2:2. [PMID: 32903320 PMCID: PMC7422482 DOI: 10.1186/s42490-020-0036-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Although not intended to tolerate high loads and deformation, it becomes a weight-bearing structure within the residuum-prosthesis-complex. Consequently, deep soft tissue layers may be damaged, resulting in Deep Tissue Injury (DTI). Whilst considerable effort has gone into DTI research on immobilised individuals, only little is known about the aetiology and population-specific risk factors in amputees. This scoping review maps out and critically appraises existing research on DTI in lower-limb prosthetic users according to (1) the population-specific aetiology, (2) risk factors, and (3) methodologies to investigate both. Results A systematic search within the databases Pubmed, Ovid Excerpta Medica, and Scopus identified 16 English-language studies. The results indicate that prosthetic users may be at risk for DTI during various loading scenarios. This is influenced by individual surgical, morphological, and physiological determinants, as well as the choice of prosthetic componentry. However, methodological limitations, high inter-patient variability, and small sample sizes complicate the interpretation of outcome measures. Additionally, fundamental research on cell and tissue reactions to dynamic loading and on prosthesis-induced alterations of the vascular and lymphatic supply is missing. Conclusion We therefore recommend increased interdisciplinary research endeavours with a focus on prosthesis-related experimental design to widen our understanding of DTI. The results have the potential to initiate much-needed clinical advances in surgical and prosthetic practice and inform future pressure ulcer classifications and guidelines.
Collapse
Affiliation(s)
- Marisa Graser
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| | - Arjan Buis
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| |
Collapse
|
31
|
McGhee DE, Mikilewicz KL, Steele JR. Effect of external breast prosthesis mass on bra strap loading and discomfort in women with a unilateral mastectomy. Clin Biomech (Bristol, Avon) 2020; 73:86-91. [PMID: 31958702 DOI: 10.1016/j.clinbiomech.2019.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/03/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A common complaint of women who wear external breast prostheses following mastectomy is that they are too heavy. This study aimed to investigate the effect of external breast prosthesis mass on bra strap loading, discomfort and perceived pressure in women with a unilateral mastectomy. METHODS Pressures exerted at the bra strap-shoulder interface and ratings of discomfort and perceived pressure (visual analogue scales; 0-12 cm) were recorded for 17 women (mean 68 (SD 5.7) years) who had a unilateral mastectomy. Data were collected during standing and walking while the women wore a Lightweight prosthesis and Standard-weight prosthesis. Pressure, discomfort and perceived pressure between the two prosthesis conditions were compared using Wilcoxon Signed Ranks and the sum of the pressure values during walking and standing were correlated with discomfort and perceived pressure scores using Spearman's Rho tests. FINDINGS Mean peak bra strap pressures were significantly less when the participants wore the Lightweight prosthesis compared to the Control prosthesis during walking (0.28 (SD 0.14) N/cm2 versus 0.35 (SD 0.20) N/cm2; P < 0.05) but not during standing. No significant main effect of prosthesis mass on the participants' ratings of discomfort or perceived pressure were found, which were highly variable. INTERPRETATION Reducing external breast prosthesis mass decreased mean peak bra strap pressures during walking but this was not accompanied with reductions in bra strap-shoulder discomfort or perceived pressure. Treatment strategies to decrease bra strap-shoulder interface loading due to external breast prostheses mass could assist women who complain of prosthesis heaviness during physical activity.
Collapse
Affiliation(s)
- Deirdre E McGhee
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
| | - Katelyn L Mikilewicz
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia
| | - Julie R Steele
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
| |
Collapse
|
32
|
Boyle CJ, Carpanen D, Pandelani T, Higgins CA, Masen MA, Masouros SD. Lateral pressure equalisation as a principle for designing support surfaces to prevent deep tissue pressure ulcers. PLoS One 2020; 15:e0227064. [PMID: 31899778 PMCID: PMC6941906 DOI: 10.1371/journal.pone.0227064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
When immobile or neuropathic patients are supported by beds or chairs, their soft tissues undergo deformations that can cause pressure ulcers. Current support surfaces that redistribute under-body pressures at vulnerable body sites have not succeeded in reducing pressure ulcer prevalence. Here we show that adding a supporting lateral pressure can counter-act the deformations induced by under-body pressure, and that this 'pressure equalisation' approach is a more effective way to reduce ulcer-inducing deformations than current approaches based on redistributing under-body pressure. A finite element model of the seated pelvis predicts that applying a lateral pressure to the soft tissue reduces peak von Mises stress in the deep tissue by a factor of 2.4 relative to a standard cushion (from 113 kPa to 47 kPa)-a greater effect than that achieved by using a more conformable cushion, which reduced von Mises stress to 75 kPa. Combining both a conformable cushion and lateral pressure reduced peak von Mises stresses to 25 kPa. The ratio of peak lateral pressure to peak under-body pressure was shown to regulate deep tissue stress better than under-body pressure alone. By optimising the magnitude and position of lateral pressure, tissue deformations can be reduced to that induced when suspended in a fluid. Our results explain the lack of efficacy in current support surfaces and suggest a new approach to designing and evaluating support surfaces: ensuring sufficient lateral pressure is applied to counter-act under-body pressure.
Collapse
Affiliation(s)
- Colin J. Boyle
- Department of Bioengineering, Imperial College London, London, United
Kingdom
- Department of Mechanical Engineering, Imperial College London, London,
United Kingdom
- * E-mail:
| | - Diagarajen Carpanen
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Thanyani Pandelani
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Claire A. Higgins
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Marc A. Masen
- Department of Mechanical Engineering, Imperial College London, London,
United Kingdom
| | - Spyros D. Masouros
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| |
Collapse
|
33
|
An Investigation of Pressure Profiles and Wearer Comfort During Walking With a Transtibial Hydrocast Socket. Am J Phys Med Rehabil 2019; 98:199-206. [PMID: 30222605 DOI: 10.1097/phm.0000000000001043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of the study were to conduct an investigation of the transtibial hydrocast socket interface pressures during walking and to explore potential relationships between pressures experienced and resultant wearer comfort. DESIGN In this cross-sectional study, pressure data at the limb and hydrocast socket interface during walking were collected from 16 users of hydrocast sockets. The pressures at this interface were described by location, magnitude, and duration for all participants and were compared between the most and least comfortable participants. RESULTS High pressures were found about the bony prominences of the residual limb, especially the tibial crest of the anterior distal region. Factors identified as potentially causing discomfort (P < 0.1, d > 0.80) were high peak pressures at the anterior proximal region and longer durations of submaximal loading at the lateral proximal region and the anterior and medial distal regions. High pressure variability at the anterior proximal region may also contribute to discomfort (P = 0.106, d = 0.88). CONCLUSIONS The hydrocast socket interface pressures have been described for a cohort of users. A number of differences were found in the pressure profiles of the most and least comfortable participants. These differences suggest trends between the identified pressure parameters and resultant wearer comfort. Future studies should confirm these exploratory results.
Collapse
|
34
|
Finite element analysis reveals an important role for cell morphology in response to mechanical compression. Biomech Model Mechanobiol 2019; 19:1155-1164. [PMID: 31838604 DOI: 10.1007/s10237-019-01276-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/07/2019] [Indexed: 12/18/2022]
Abstract
Mechanical loading naturally controls cell phenotype, development, motility and various other biological functions; however, prolonged or substantial loading can cause cell damage and eventual death. Loading-induced mechanobiological and mechanostructural responses of different cell types affect their morphology and the internal architecture and the mechanics of the cellular components. Using single, mesenchymal stem cells, we have developed a cell-specific three-dimensional finite-element model; cell models were developed from phase-contrast microscopy images. This allowed us to evaluate the mechanostructural response of the naturally occurring variety of cell morphologies to increase sustained compressive loading. We focus on the morphology of the cytoplasm and the nucleus, as the main mechanically responsive elements, and evaluate formation of tensional strains and area changes in cells undergoing increasing uniaxial compressions. Here, we study mesenchymal stem cells as a model, due to their important role in tissue engineering and regenerative medicine; the method and findings are, however, applicable to any cell type. We observe variability in the cell responses to compression, which correlate directly with the morphology of the cells. Specifically, in cells with or without elongated protrusions (i.e., lamellipodia) tensional strains were, respectively, distributed mostly in the thin extensions or concentrated around the stiff nucleus. Thus, through cell-specific computational modeling of mechanical loading we have identified an underlying cause for stiffening (by actin recruitment) along the length of lamellipodia as well as a role for cell morphology in inducing cell-to-cell variability in mechanostructural response to loading.
Collapse
|
35
|
Van Damme N, Van Hecke A, Remue E, Van den Bussche K, Moore Z, Gefen A, Verhaeghe S, Beeckman D. Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review. Wound Repair Regen 2019; 28:242-265. [DOI: 10.1111/wrr.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Eline Remue
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Nursing departmentGhent University Hospital Ghent Belgium
| | - Karen Van den Bussche
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Zena Moore
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv University Tel Aviv Israel
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Department of Health CareVIVES University of Applied Sciences Roeselare Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
- School of Health SciencesÖrebro University Örebro Sweden
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health SciencesUniversity of Southern Denmark Odense Denmark
- School of Nursing and MidwiferyMonash University Melbourne Australia
| |
Collapse
|
36
|
Boyle CJ, Plotczyk M, Villalta SF, Patel S, Hettiaratchy S, Masouros SD, Masen MA, Higgins CA. Morphology and composition play distinct and complementary roles in the tolerance of plantar skin to mechanical load. SCIENCE ADVANCES 2019; 5:eaay0244. [PMID: 31633031 PMCID: PMC6785259 DOI: 10.1126/sciadv.aay0244] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/10/2019] [Indexed: 05/05/2023]
Abstract
Plantar skin on the soles of the feet has a distinct morphology and composition that is thought to enhance its tolerance to mechanical loads, although the individual contributions of morphology and composition have never been quantified. Here, we combine multiscale mechanical testing and computational models of load bearing to quantify the mechanical environment of both plantar and nonplantar skin under load. We find that morphology and composition play distinct and complementary roles in plantar skin's load tolerance. More specifically, the thick stratum corneum provides protection from stress-based injuries such as skin tears and blisters, while epidermal and dermal compositions provide protection from deformation-based injuries such as pressure ulcers. This work provides insights into the roles of skin morphology and composition more generally and will inform the design of engineered skin substitutes as well as the etiology of skin injury.
Collapse
Affiliation(s)
- Colin J. Boyle
- Department of Bioengineering, Imperial College London, London, UK
| | | | | | - Sharad Patel
- Department of Bioengineering, Imperial College London, London, UK
| | - Shehan Hettiaratchy
- Department of Bioengineering, Imperial College London, London, UK
- Department of Surgery, Imperial College London, London, UK
| | | | - Marc A. Masen
- Department of Bioengineering, Imperial College London, London, UK
- Department of Mechanical Engineering, Imperial College London, London, UK
| | | |
Collapse
|
37
|
Alvarez-Elizondo MB, Barenholz-Cohen T, Weihs D. Sodium pyruvate pre-treatment prevents cell death due to localised, damaging mechanical strains in the context of pressure ulcers. Int Wound J 2019; 16:1153-1163. [PMID: 31407500 DOI: 10.1111/iwj.13173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/26/2019] [Indexed: 12/27/2022] Open
Abstract
We demonstrate sodium pyruvate (NaPy) pre-treatment as a successful approach for pressure ulcer (PU) prevention by averting their aetiological origin-cell-level damage and death by large, sustained mechanical loads. We evaluated the NaPy pre-treatment effect on permeability changes in the cell's plasma membrane (PM) following application of in vitro damaging-level strains. Fibroblasts or myoblasts, respectively, models for superficial or deep-tissue damage were grown in 0 or 1 mM NaPy, emulating typical physiological or cell culture conditions. Cells were pre-treated for 4 hours with 0 to 5 mM NaPy prior to 3-hour sustained, damaging-level loads (12% strain). PM permeability was quantified by the cell uptake of small (4 kDa), fluorescent dextran compared with unstrained control using fluorescence-activated cell sorting (FACS). Pre-treatment with 1 mM, and especially 5 mM, NaPy significantly reduces damage to PM integrity. Long-term NaPy pre-exposure can improve protective treatment, affecting fibroblasts and myoblasts differently. Pre-treating with NaPy, a natural cell metabolite, allows cells under damaging-level mechanical loads to maintain their PM integrity, that is, to avoid loss of homeostasis and inevitable, eventual cell death, by preventing initial, microscale stages of PU formation. This pre-treatment may be applied prior to planned periods of immobility, for example, planned surgery or transport, to prolong safe time in a position by preventing initial cell damage that can cascade and lead to PU formation.
Collapse
Affiliation(s)
| | - Tamar Barenholz-Cohen
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daphne Weihs
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
38
|
Bullkich E, Kimmel E, Golan S. A novel ischemia reperfusion injury hereditary tissue model for pressure ulcers progression. Biomech Model Mechanobiol 2019; 18:1847-1866. [DOI: 10.1007/s10237-019-01181-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/31/2019] [Indexed: 01/28/2023]
|
39
|
Gould LJ, Bohn G, Bryant R, Paine T, Couch K, Cowan L, McFarland F, Simman R. Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage. Wound Repair Regen 2019; 27:497-508. [DOI: 10.1111/wrr.12730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lisa J. Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
| | | | - Ruth Bryant
- Abbott Northwestern Hospital Minneapolis Minnesota
| | - Tim Paine
- Department of RehabilitationLitchfield Hills Orthopedic Torrington Connecticut
| | - Kara Couch
- Wound Healing and Limb Preservation CenterGeorge Washington University Hospital Washington District of Columbia
| | - Linda Cowan
- Center of Innovation on Disability and Rehabilitation ResearchVirginia Health Care Richmond Virginia
| | | | - Richard Simman
- Jobst Vascular InstituteUniversity of Toledo College of Medicine Toledo Ohio
| |
Collapse
|
40
|
Leung IPH, Fleming LT, Walton K, Barrans SM, Ousey K. Finite element analysis to model ischemia experienced in the development of device related pressure ulcers. Proc Inst Mech Eng H 2019; 233:745-753. [DOI: 10.1177/0954411919851387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Isaac PH Leung
- Centre for Precision Technologies (CPT), School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Leigh T Fleming
- Materials and Engineering Research Institute (MERI), Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield, UK
| | - Karl Walton
- Centre for Precision Technologies (CPT), School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Simon M Barrans
- Turbocharger Research Institute, University of Huddersfield, Huddersfield, UK
| | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
41
|
Traa WA, van Turnhout MC, Nelissen JL, Strijkers GJ, Bader DL, Oomens CWJ. There is an individual tolerance to mechanical loading in compression induced deep tissue injury. Clin Biomech (Bristol, Avon) 2019; 63:153-160. [PMID: 30897463 DOI: 10.1016/j.clinbiomech.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep tissue injury is a type of pressure ulcer which originates subcutaneously due to sustained mechanical loading. The relationship between mechanical compression and damage development has been extensively studied in 2D. However, recent studies have suggested that damage develops beyond the site of indentation. The objective of this study was to compare mechanical loading conditions to the associated damage in 3D. METHODS An indentation test was performed on the tibialis anterior muscle of rats (n = 39). Changes in the form of oedema and structural damage were monitored with MRI in an extensive region. The internal deformations were evaluated using MRI based 3D finite element models. FINDINGS Damage propagates away from the loaded region. The 3D analysis indicates that there is a subject specific tolerance to compression induced deep tissue injury. INTERPRETATION Individual tolerance is an important factor when considering the mechanical loading conditions which induce damage.
Collapse
Affiliation(s)
- Willeke A Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Mark C van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jules L Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Cees W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| |
Collapse
|
42
|
Macron A, Pillet H, Doridam J, Verney A, Rohan PY. Development and evaluation of a new methodology for the fast generation of patient-specific Finite Element models of the buttock for sitting-acquired deep tissue injury prevention. J Biomech 2018; 79:173-180. [PMID: 30201252 DOI: 10.1016/j.jbiomech.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/17/2018] [Accepted: 08/10/2018] [Indexed: 01/11/2023]
Abstract
The occurrence and management of Pressure Ulcers remain a major issue for patients with reduced mobility and neurosensory loss despite significant improvement in the prevention methods. These injuries are caused by biological cascades leading from a given mechanical loading state in tissues to irreversible tissue damage. Estimating the internal mechanical conditions within loaded soft tissues has the potential of improving the management and prevention of PU. Several Finite Element models of the buttock have therefore been proposed based on either MRI or CT-Scan data. However, because of the limited availability of MRI or CT-Scan systems and of the long segmentation time, all studies in the literature include the data of only one individual. Yet the inter-individual variability can't be overlooked when dealing with patient specific estimation of internal tissue loading. As an alternative, this contribution focuses on the combined use of low-dose biplanar X-ray images, B-mode ultrasound images and optical scanner acquisitions in a non-weight-bearing sitting posture for the fast generation of patient-specific FE models of the buttock. Model calibration was performed based on Ischial Tuberosity sagging. Model evaluation was performed by comparing the simulated contact pressure with experimental observations on a population of 6 healthy subjects. Analysis of the models confirmed the high inter-individual variability of soft tissue response (maximum Green Lagrange shear strains of 213 ± 101% in the muscle). This methodology opens the way for investigating inter-individual factors influencing the soft tissue response during sitting and for providing tools to assess PU risk.
Collapse
Affiliation(s)
- Aurélien Macron
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France; Univ. Grenoble Alpes, CEA, LETI, CLINATEC, MINATEC Campus, 38000 Grenoble, France.
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| | - Jennifer Doridam
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| | - Alexandre Verney
- CEA, LIST, Interactive Robotics Laboratory, F-91191 Gif-sur-Yvette, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| |
Collapse
|
43
|
Moreau-Gaudry A, Chenu O, Dang MV, Bosson JL, Hommel M, Demongeot J, Cannard F, Diot B, Prince A, Hughes C, Vuillerme N, Payan Y. Reduction of Prolonged Excessive Pressure in Seated Persons With Paraplegia Using Wireless Lingual Tactile Feedback: A Randomized Controlled Trial. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:2100611. [PMID: 29984117 PMCID: PMC6033051 DOI: 10.1109/jtehm.2018.2842746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/26/2018] [Accepted: 05/25/2018] [Indexed: 11/10/2022]
Abstract
Pressure ulcers (PU) are known to be a high-cost disease with a risk of severe morbidity. This paper evaluates a new clinical strategy based on an innovative medical device [Tongue Display Unit (TDU)] that implements perceptive supplementation in order to reduce prolonged excessive pressure, recognized as one of the main causes of PU. A randomized, controlled, and parallel-group trial was carried out with 12 subjects with spinal cord injuries (SCI). Subjects were assigned to the control (without TDU, [Formula: see text]) or intervention (with TDU, [Formula: see text]) group. Each subject took part in two sessions, during which the subject, seated on a pressure map sensor, watched a movie for one hour. The TDU was activated during the second session of the intervention group. Intention-to-treat analysis showed that the improvement in adequate weight shifting between the two sessions was higher in the intervention group (0.84 [0.24; 0.89]) than in the control group (0.01 [-0.01; 0.09]; [Formula: see text]) and that the ratio of prolonged excessive pressure between the two sessions was lower in the intervention group (0.74 [0.37; 1.92]) than in the control group (1.72 [1.32; 2.56]; [Formula: see text]). The pressure map sensor was evaluated as being convenient for use in daily life; however, this was not the case for the TDU. This paper shows that persons with SCI could benefit from a system based on perceptive supplementation that alerts and guides the user on how to adapt their posture in order to reduce prolonged excessive pressure, one of the main causes of PU.
Collapse
Affiliation(s)
- A Moreau-Gaudry
- INSERM CIC 140638000GrenobleFrance.,Grenoble Alpes University Hospital38700La TroncheFrance.,Université Grenoble Alpes, TIMC-IMAG38400GrenobleFrance.,CNRSTIMC-IMAG38706La TroncheFrance
| | - O Chenu
- TexiSense S.A. Company71300Montceau-les-minesFrance
| | - M V Dang
- Centre Hospitalier de Saint-Laurent-du-Pont38380Saint-Laurent-du-PontFrance
| | - J-L Bosson
- INSERM CIC 140638000GrenobleFrance.,Grenoble Alpes University Hospital38700La TroncheFrance.,Université Grenoble Alpes, TIMC-IMAG38400GrenobleFrance.,CNRSTIMC-IMAG38706La TroncheFrance
| | - M Hommel
- INSERM CIC 140638000GrenobleFrance.,Grenoble Alpes University Hospital38700La TroncheFrance
| | - J Demongeot
- Université Grenoble Alpes, TIMC-IMAG38400GrenobleFrance.,Institut Universitaire de France75231ParisFrance
| | - F Cannard
- TexiSense S.A. Company71300Montceau-les-minesFrance
| | - B Diot
- IDS S.A.71300Montceau-les-minesFrance
| | - A Prince
- Clinique du Grésivaudan38700La TroncheFrance
| | - C Hughes
- INSERM CIC 140638000GrenobleFrance.,Université Grenoble Alpes, CIC 140638000GrenobleFrance.,Grenoble Alpes University Hospital, CIC 140638000GrenobleFrance
| | - N Vuillerme
- Institut Universitaire de France75231ParisFrance.,Université Grenoble Alpes, AEGIS38400GrenobleFrance
| | - Y Payan
- Université Grenoble Alpes, TIMC-IMAG38400GrenobleFrance.,CNRSTIMC-IMAG38706La TroncheFrance
| |
Collapse
|
44
|
Nelissen JL, Traa WA, de Boer HH, de Graaf L, Mazzoli V, Savci-Heijink CD, Nicolay K, Froeling M, Bader DL, Nederveen AJ, Oomens CWJ, Strijkers GJ. An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury. J Appl Physiol (1985) 2018; 124:1580-1596. [DOI: 10.1152/japplphysiol.00891.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T2, T2*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T2 corresponded with edema, muscle cell damage, and inflammation. T2* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue’s microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.
Collapse
Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans H. de Boer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Mazzoli
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Orthopedic Research Laboratory, Radboud UMC, Nijmegen, The Netherlands
| | | | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dan L. Bader
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees W. J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
45
|
Chen JH, Wu SC, Chen HJ, Kao CH, Tseng CH, Tsai CH. Risk of developing pressure sore in amyotrophic lateral sclerosis patients - a nationwide cohort study. J Eur Acad Dermatol Venereol 2018; 32:1589-1596. [PMID: 29512203 DOI: 10.1111/jdv.14911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept. OBJECTIVE To investigate whether patients with ALS have higher risk of PrS. METHODS Utilizing a Taiwan National Insurance claims data set with 23 million participants, we extracted 514 patients with ALS and 2056 controls from 1 January 2000 to 31 December 2008. Both groups were followed up until PrS occurrence during study period (2000-2011). The PrS risk was calculated with Cox proportional regression model. RESULTS The patients with ALS had a greater PrS risk (adjusted hazard ratio [aHR] = 8.82, 95% confidence interval [CI] = 4.90-15.9, P < 0.001) than the controls did. PrS risk was much higher in ALS women (aHR = 26.6, 95% CI = 9.05-78.2, P < 0.001) than in ALS men (aHR = 4.38, 95% CI = 1.99-9.68, P < 0.001). Besides, in people aged 20-54, ALS was linked with a much greater PrS risk (aHR = 27.7, 95% CI = 5.79-132, P < 0.001) than in those aged ≥55 (aHR = 6.10, 95% CI = 3.10-12.0, P < 0.001). CONCLUSIONS Amyotrophic lateral sclerosis is discovered to be correlated with an enhanced PrS risk. For PrS prevention, it is needed to pay more attention to the management of the patients with ALS, particularly in women and those with relatively younger age. Further investigations are needed to confirm the findings in this study.
Collapse
Affiliation(s)
- J-H Chen
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - S-C Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
| | - H-J Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - C-H Kao
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - C-H Tseng
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - C-H Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
46
|
Bader DL, Worsley PR. Technologies to monitor the health of loaded skin tissues. Biomed Eng Online 2018; 17:40. [PMID: 29650012 PMCID: PMC5897925 DOI: 10.1186/s12938-018-0470-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/24/2018] [Indexed: 01/18/2023] Open
Abstract
There are many situations where the skin and underlying soft tissues are compromised by mechanical loading in the form or pressure, or pressure in combination with shear. If sustained, this can lead to damage in the tissues particularly adjacent to bony prominences, resulting in chronic wounds. An array of bioengineering technologies have been adopted to assess the integrity of loaded soft tissues. This paper aims to review these approaches for the quantification, simulation and early detection of mechanically-induced skin damage. The review considers different measurements at the interface between the skin and support surface/medical device, involving pressure, shear, friction and the local microclimate. The potential of the techniques to monitor the physiological response of the skin to these external stimuli including biophysical measurement devices and sampling of biofluids are critically analysed. In addition, it includes an analysis of medical imaging technologies and computational modelling to provide a means by which tissue deformation can be quantified and thresholds for tissue damage defined. Bioengineering measurement and imaging technologies have provided an insight into the temporal status of loaded skin. Despite the advances in technology, to date, the translation to clinical tools which are robust and cost effective has been limited. There is a need to adapt existing technologies and simulation platforms to enable patients, carers and clinicians to employ appropriate intervention strategies to minimise soft tissue damage.
Collapse
Affiliation(s)
- Dan L Bader
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter R Worsley
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| |
Collapse
|
47
|
An MRI investigation of the effects of user anatomy and wheelchair cushion type on tissue deformation. J Tissue Viability 2018; 27:42-53. [DOI: 10.1016/j.jtv.2017.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 11/18/2022]
|
48
|
Al-Dirini RMA, Nisyrios J, Reed MP, Thewlis D. Quantifying the in vivo quasi-static response to loading of sub-dermal tissues in the human buttock using magnetic resonance imaging. Clin Biomech (Bristol, Avon) 2017; 50:70-77. [PMID: 28987874 DOI: 10.1016/j.clinbiomech.2017.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The design of seating systems to improve comfort and reduce injury would benefit from improved understanding of the deformation and strain patterns in soft tissues, particularly in the gluteal region. METHODS Ten healthy men were positioned in a semi-recumbent posture while their pelvic and thigh region was scanned using a wide-bore magnetic resonance imaging (MRI) scanner. Independent measurements of deformation for muscles and fat were taken for the transition from non-weight-bearing to weight-bearing loads in three stages. A weight-bearing load was achieved through having the subject supported by a flat, rigid surface. A non-weight-bearing condition was achieved by removing the support under the left buttock, leaving all soft tissue layers undeformed. An intermediate condition partially relieved the subject's left buttock by lowering the support relative to the pelvis by 20mm, which left the buttock partially deformed. For each of these conditions, the thicknesses of muscle and fat tissues below the ischial tuberosity and the greater trochanter were measured from the MRI data. FINDINGS In this dataset, the greatest soft tissue deformation took place below the ischial tuberosity, with muscles (mean=17.7mm, SD=4.8mm) deforming more than fat tissues (mean=4.3mm, SD=5.6mm). Muscles deformed through both steps of the transition from weight-bearing to non-weight-bearing conditions, while subcutaneous fat deformed little after the first transition from non-weight-bearing to partial-weight-bearing. High inter-subject variability in muscle and fat tissue strains was observed. INTERPRETATION Our findings highlight the importance of considering inter-subject variability when designing seating systems.
Collapse
Affiliation(s)
- Rami M A Al-Dirini
- Medical Devices Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA 5001, Australia.
| | - John Nisyrios
- Fowler Simmons Radiology, Adelaide, SA 5000, Australia
| | - Matthew P Reed
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| |
Collapse
|
49
|
Oliveira AL, Moore Z, O Connor T, Patton D. Accuracy of ultrasound, thermography and subepidermal moisture in predicting pressure ulcers: a systematic review. J Wound Care 2017; 26:199-215. [PMID: 28475447 DOI: 10.12968/jowc.2017.26.5.199] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Our aims were to: establish the clinical significance of ultrasound, thermography, photography and subepidermal moisture (SEM) measurement; determine the accuracy of ultrasound, thermography, photography and SEM measurement in detecting skin/tissue damage; determine the relative accuracy of one of these assessment methods over another; make recommendations for practice pertaining to assessment of early skin/tissue damage. METHOD The following databases, Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, Elsevier version, EBSCO CINAHL, ClinicalTrials.gov , WHO International Clinical Trials Registry (ICTR) and The EU Clinical Trials Register were searched for terms including; thermography, ultrasound, subepidermal moisture, photograph and pressure ulcer. RESULTS We identified four SEM, one thermography and five ultrasound studies for inclusion in this review. Data analysis indicated that photography was not a method which allowed for the early prediction of PU presence. SEM values increased with increasing tissue damage, with the sacrum and the heels being the most common anatomical locations for the development of erythema and stage I PUs. Thermography identified temperature changes in tissues and skin that may give an indication of early PU development; however the data were not sufficiently robust. Ultrasound detected pockets of fluid/oedema at different levels of the skin that were comparable with tissue damage. Thus, SEM and ultrasound were the best methods for allowing a more accurate assessment of early skin/tissue damage. Using the EBL Critical Appraisal Tool the overall validities of the studies varied between 33.3-55.6%, meaning that there is potential for bias within all the included studies. All of the studies were situated at level IV, V and VII of the evidence pyramid. Although the methodological quality of the studies warrants consideration, these studies showed the potential that SEM and ultrasound have in early PU detection. CONCLUSION SEM and ultrasound are promising in the detection and prediction of early tissue damage and PU presence. However, these methods should be further studied to clarify their potential for use more widely in PU prevention strategies.
Collapse
Affiliation(s)
- A L Oliveira
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| | - Z Moore
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| | - T O Connor
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| | - D Patton
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| |
Collapse
|
50
|
Dickinson A, Steer J, Worsley P. Finite element analysis of the amputated lower limb: A systematic review and recommendations. Med Eng Phys 2017; 43:1-18. [DOI: 10.1016/j.medengphy.2017.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/18/2023]
|