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Pignet AL, Schellnegger M, Hecker A, Kamolz LP, Kotzbeck P. Modeling Wound Chronicity In Vivo: The Translational Challenge to Capture the Complexity of Chronic Wounds. J Invest Dermatol 2024; 144:1454-1470. [PMID: 38483357 DOI: 10.1016/j.jid.2023.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 06/24/2024]
Abstract
In an aging society with common lifestyle-associated health issues such as obesity and diabetes, chronic wounds pose a frequent challenge that physicians face in everyday clinical practice. Therefore, nonhealing wounds have attracted much scientific attention. Several in vitro and in vivo models have been introduced to deepen our understanding of chronic wound pathogenesis and amplify therapeutic strategies. Understanding how wounds become chronic will provide insights to reverse or avoid chronicity. Although choosing a suitable model is of utmost importance to receive valuable outcomes, an ideal in vivo model capturing the complexity of chronic wounds is still missing and remains a translational challenge. This review discusses the most relevant mammalian models for wound healing studies and provides guidance on how to implement the hallmarks of chronic wounds. It highlights the benefits and pitfalls of established models and maps out future avenues for research.
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Affiliation(s)
- Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH, Graz, Austria; Research Unit for Tissue Repair and Reconstruction, Medical University of Graz, Graz, Austria
| | - Marlies Schellnegger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH, Graz, Austria; Research Unit for Tissue Repair and Reconstruction, Medical University of Graz, Graz, Austria.
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH, Graz, Austria; Research Unit for Tissue Repair and Reconstruction, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH, Graz, Austria
| | - Petra Kotzbeck
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; COREMED - Centre for Regenerative and Precision Medicine, JOANNEUM RESEARCH, Graz, Austria; Research Unit for Tissue Repair and Reconstruction, Medical University of Graz, Graz, Austria
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Prevención de lesiones por presión en pacientes sometidos a cirugía traumatológica prolongada, un desafío para enfermería. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lichterfeld-Kottner A, Vogt A, Tomova-Simitchieva T, Blume-Peytavi U, Kottner J. Effects of loading and prophylactic dressings on the sacral and heel skin: An exploratory cross-over trial. Int Wound J 2021; 18:909-922. [PMID: 33939289 PMCID: PMC8613394 DOI: 10.1111/iwj.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023] Open
Abstract
Pressure ulcers/injuries are caused by sustained loading and deformation of skin and underlying soft tissues. Prophylactic dressings are recommended as an adjunct to other preventive measures such as repositioning and offloading. The aim of this study was to investigate the effects of prophylactic soft silicone multi‐layered foam dressings on the skin structure and function of the two most common pressure areas, sacrum and heel, with and without loading. An exploratory randomised cross‐over trial using intra‐individual comparisons was conducted. Eight healthy volunteers (mean age 27.5 years) were assigned to three groups and either spent 2.5 hours on a standard hospital mattress lying in supine position with and without dressings or spent 2.5 hours with dressings applied but without loading. Skin temperature, stratum corneum, and epidermal hydration increased in all groups irrespective of wearing a dressing and/or loading. Mean roughness decreased at the heels. Reactive hyperaemia and the release of interleukin 1 alpha were associated with loading only. Results suggest that the occlusive effects of dressings are similar or only slightly greater than those observed with non‐loading or loading without dressings. Thus, a dressing does not cause additional irritation or skin changes during loading but it may reduce the inflammatory response.
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Affiliation(s)
- Andrea Lichterfeld-Kottner
- Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Nursing Research Group, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annika Vogt
- Department of Dermatology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Department of Dermatology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Charite Center for Health and Human Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Blackburn J, Ousey K, Taylor L, Moore B, Patton D, Moore Z, Avsar P. The relationship between common risk factors and the pathology of pressure ulcer development: a systematic review. J Wound Care 2020; 29:S4-S12. [PMID: 32160123 DOI: 10.12968/jowc.2020.29.sup3.s4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this systematic review was to examine the associations and relationship between commonly cited risk factors and the pathology of pressure ulcer (PU) development. METHOD Using systematic review methodology, original research studies, prospective design and human studies written in English were included. The search was conducted in March 2018, using Ovid, Ovid EMBASE and CINAHL databases. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the evidence-based librarianship critical appraisal. RESULTS A total of 382 records were identified, of which five met the inclusion criteria. The studies were conducted between 1994 and 2017. Most studies were conducted in hospital and geriatric wards. The mean sample size was 96±145.7 participants. Ischaemia, recovery of blood flow and pathological impact of pressure and shear was mainly found as the cited risk factor and PU aetiology. CONCLUSION This review systematically analysed five papers exploring the relationship between risk factors for PU development and aetiology. It identified many risk factors and underlying pathological mechanisms that interact in the development of PU including ischaemia, stress, recovery of blood flow, tissue hypoxia and the pathological impact of pressure and shear. There are several pathways in which these pathological mechanisms contribute to PU development and identifying these could establish potential ways of preventing or treating the development of PU for patients.
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Affiliation(s)
- Joanna Blackburn
- 1 Research Fellow, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Karen Ousey
- 2 Professor of Skin Integrity, Director Institute of Skin Integrity and Infection Prevention University of Huddersfield, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, UK.,3 Clinical Professor, Queensland University of Technology, Australia
| | - Lauren Taylor
- 4 Research Registrar, Pinderfields Research Unit, Pinderfields General Hospital, UK
| | - Barry Moore
- 5 Chartered Physiotherapist, Tallaght University Hospital, Dublin 24, Ireland
| | - Declan Patton
- 6 Senior Lecturer, Director of Nursing and Midwifery Research and Deputy Director of the Skin Wounds, and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland.,7 Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.,8 Adjunct Associate Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Zena Moore
- 9 Head of School of Nursing and Midwifery and Director of the Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland (RCSI).,10 Adjunct Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,11 Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University.,12 Honorary Professor, Lida Institute, Shanghai.,13 Senior Tutor, University of Wales.,14 Adjunct Professor, School of Nursing, Fakeeh College, Jeddah, Saudi Arabia
| | - Pinar Avsar
- 15 School of Nursing and Midwifery, Royal College of Surgeons in Ireland
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Lechner A, Rancan F, Hadam S, Vogt A, Blume‐Peytavi U, Kottner J. Comparing the effects of three different multilayer dressings for pressure ulcer prevention on sacral skin after prolonged loading: An exploratory crossover trial. Wound Repair Regen 2020; 29:270-279. [DOI: 10.1111/wrr.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Anna Lechner
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Fiorenza Rancan
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Sabrina Hadam
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jan Kottner
- Charité Center Health and Human Sciences Charité – Universitätsmedizin Berlin Berlin Germany
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Pressure ulcer/injury classification today: An international perspective. J Tissue Viability 2020; 29:197-203. [DOI: 10.1016/j.jtv.2020.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
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Henni S, Hersant J, Loufrani L, Duval G, Humeau-Heurtier A, Riou J, Abraham P. Painless local pressure application to test microvascular reactivity to ischemia. Microvasc Res 2018; 122:13-21. [PMID: 30399363 DOI: 10.1016/j.mvr.2018.10.013] [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: 06/29/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Forearm cutaneous blood flux (CBF) measurement with post-occlusive reactive hyperemia (PORH) is uncomfortable and may not be devoid of risks. We aimed to investigate post-compression reactive hyperemia (PCRH) with a custom-made indenter that was designed to be easily used routinely by inexperienced observers. METHODS Medical students evaluated PCRH with 1- to 4-min pressure applications of 16 to 34 kPa and PORH with 3-min forearm cuff occlusion using laser speckle contrast imaging in 15 healthy volunteers. Participants were asked to quantify their discomfort with a visual analogue scale (VAS) of 10 cm. Total ischemia (ISCH) was quantified by the product of CBF during ischemia and ischemia duration (min). We subtracted the CBF changes in the skin from a reference ipsilateral (PCRH) or contralateral (PORH) non-stimulated area. RESULTS The average VAS was 1.0 for PCRH vs. 6.0 for PORH (p < 0.001). A strong linear relationship between ISCH and peak PCRH (r2 = 0.915, p < 0.001) was noted. Peak PORH values (63.9 laser perfusion units (LPU)) were significantly lower than all values of the 3-min PCRH (72.6 LPU), including the one obtained with 16 kPa. CONCLUSION Inexperienced observers could test microvascular reactivity with PCRH without inducing the discomfort that is typically experienced with PORH. Further, PCRH elicits a higher peak response to ischemia compared with PORH. This extremely simple method could influence a broad spectrum of routine cutaneous microcirculation investigations, especially when a painful approach is particularly inadequate or if the patient is fragile. CLINICAL TRIAL REGISTRATION NCT02861924.
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Affiliation(s)
- Samir Henni
- Vascular Medicine, University Hospital of Angers, France; MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Jeanne Hersant
- Vascular Medicine, University Hospital of Angers, France; MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Laurent Loufrani
- MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Guillaume Duval
- Department of Gerontology, University Hospital of Angers, France
| | - Anne Humeau-Heurtier
- Université Angers, LARIS - Laboratoire Angevin de Recherche en Ingénierie des Systèmes, Angers, France
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- Vascular Medicine, University Hospital of Angers, France
| | - Jeremie Riou
- UMR Inserm 1066 - CNRS 6021, Faculté de Médecine, Angers, France
| | - Pierre Abraham
- MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France; Sports Medicine, University Hospital of Angers, France.
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Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical Care Patients. J Wound Ostomy Continence Nurs 2017; 44:420-428. [PMID: 28671894 DOI: 10.1097/won.0000000000000349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the current study was to examine the relationship between pressure injury development and the Braden Scale for Pressure Sore Risk subscale scores in a surgical intensive care unit (ICU) population and to ascertain whether the risk represented by the subscale scores is different between older and younger patients. DESIGN Retrospective review of electronic medical records. SUBJECTS AND SETTING The sample comprised patients admitted to the ICU at an academic medical center in the Western United States (Utah) and Level 1 trauma center between January 1, 2008 and May 1, 2013. Analysis is based on data from 6377 patients. METHODS Retrospective chart review was used to determine Braden Scale total and subscale scores, age, and incidence of pressure injury development. We used survival analysis to determine the hazards of developing a pressure injury associated with each subscale of the Braden Scale, with the lowest-risk category as a reference. In addition, we used time-dependent Cox regression with natural cubic splines to model the interaction between age and Braden Scale scores and subscale scores in pressure injury risk. RESULTS Of the 6377 ICU patients, 214 (4%) developed a pressure injury (stages 2-4, deep tissue injury, or unstageable) and 516 (8%) developed a hospital-acquired pressure injury of any stage. With the exception of the friction and shear subscales, regardless of age, individuals with scores in the intermediate-risk levels had the highest likelihood of developing pressure injury. CONCLUSION The relationship between age, Braden Scale subscale scores, and pressure injury development varied among subscales. Maximal preventive efforts should be extended to include individuals with intermediate Braden Scale subscale scores, and age should be considered along with the subscale scores as a factor in care planning.
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Clinical and biomechanical perspectives on pressure injury prevention research: The case of prophylactic dressings. Clin Biomech (Bristol, Avon) 2016; 38:29-34. [PMID: 27564577 DOI: 10.1016/j.clinbiomech.2016.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
In this perspective paper, we discuss clinical and biomechanical viewpoints on pressure injury (or pressure ulcer) prevention research. We have selected to focus on the case of prophylactic dressings for pressure injury prevention, and the background of the historical context of pressure injury research, as an exemplar to illuminate some of the good and not so good in current biomechanical and clinical research in the wound prevention and care arena. Investigators who are conducting medical or clinical research in academia, in medical settings or in industry to determine the efficacy of wound prevention and care products could benefit from applying some basic principles that are detailed in this paper, and that should leverage the research outcomes, thereby contributing to setting higher standards in the field.
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