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Marché C, Creehan S, Gefen A. The frictional energy absorber effectiveness and its impact on the pressure ulcer prevention performance of multilayer dressings. Int Wound J 2024; 21:e14871. [PMID: 38591160 PMCID: PMC11002638 DOI: 10.1111/iwj.14871] [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: 01/25/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Pressure ulcers including heel ulcers remain a global healthcare concern. This study comprehensively evaluates the biomechanical effectiveness of the market-popular ALLEVYN® LIFE multilayer dressing in preventing heel ulcers. It focuses on the contribution of the frictional sliding occurring between the non-bonded, fully independent layers of this dressing type when the dressing is protecting the body from friction and shear. The layer-on-layer sliding phenomenon, which this dressing design enables, named here the frictional energy absorber effectiveness (FEAE), absorbs approximately 30%-45% of the mechanical energy resulting from the foot weight, friction and shear acting to distort soft tissues in a supine position, thereby reducing the risk of heel ulcers. Introducing the novel theoretical FEAE formulation, new laboratory methods to quantify the FEAE and a review of relevant clinical studies, this research underlines the importance of the FEAE in protecting the heels of at-risk patients. The work builds on a decade of research published by our group in analysing and evaluating dressing designs for pressure ulcer prevention and will be useful for clinicians, manufacturers, regulators and reimbursing bodies in assessing the effectiveness of dressings indicated or considered for prophylactic use.
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Affiliation(s)
- Cécile Marché
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | | | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Department of Mathematics and Statistics, Faculty of SciencesHasselt UniversityHasseltBelgium
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2
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Gefen A, Alves P, Beeckman D, Cullen B, Lázaro‐Martínez JL, Lev‐Tov H, Santamaria N, Swanson T, Woo K, Söderström B, Svensby A, Malone M, Nygren E. Fluid handling by foam wound dressings: From engineering theory to advanced laboratory performance evaluations. Int Wound J 2024; 21:e14674. [PMID: 38353372 PMCID: PMC10865423 DOI: 10.1111/iwj.14674] [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: 10/22/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
This article describes the contemporary bioengineering theory and practice of evaluating the fluid handling performance of foam-based dressings, with focus on the important and clinically relevant engineering structure-function relationships and on advanced laboratory testing methods for pre-clinical quantitative assessments of this common type of wound dressings. The effects of key wound dressing material-related and treatment-related physical factors on the absorbency and overall fluid handling of foam-based dressings are thoroughly and quantitively analysed. Discussions include exudate viscosity and temperature, action of mechanical forces and the dressing microstructure and associated interactions. Based on this comprehensive review, we propose a newly developed testing method, experimental metrics and clinical benchmarks that are clinically relevant and can set the standard for robust fluid handling performance evaluations. The purpose of this evaluative framework is to translate the physical characteristics and performance determinants of a foam dressing into achievable best clinical outcomes. These guiding principles are key to distinguishing desirable properties of a dressing that contribute to optimal performance in clinical settings.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Department of Mathematics and Statistics, Faculty of SciencesHasselt UniversityHasseltBelgium
| | - Paulo Alves
- Wounds Research Lab, Centre for Interdisciplinary Research in Health, Faculty of Nursing and Health SciencesUniversidade Católica PortuguesaPortoPortugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | | | | | - Hadar Lev‐Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Hospital Miller School of MedicineMiamiFloridaUSA
| | - Nick Santamaria
- School of Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | | | - Kevin Woo
- School of NursingQueen's UniversityKingstonOntarioCanada
| | - Bengt Söderström
- Wound Care Research and DevelopmentMölnlycke Health Care ABGothenburgSweden
| | - Anna Svensby
- Wound Care Research and DevelopmentMölnlycke Health Care ABGothenburgSweden
| | - Matthew Malone
- Research and Development, Bioactives and Wound Biology, Mölnlycke Health Care AB, Gothenburg, Sweden; and Infectious Diseases and Microbiology, School of MedicineWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Erik Nygren
- Wound Care Research and DevelopmentMölnlycke Health Care ABGothenburgSweden
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3
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Fougeron N, Chagnon G, Connesson N, Alonso T, Pasquinet L, Auguste S, Perrier A, Payan Y. Finite Element Tissue Strains Computation to Evaluate the Mechanical Protection Provided by a New Bilayer Dressing for Heel Pressure Injuries. Adv Skin Wound Care 2023; 36:549-556. [PMID: 37729165 DOI: 10.1097/asw.0000000000000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Pressure injuries (PIs) result in an extended duration of care and increased risks of complications for patients. When treating a PI, the aim is to hinder further PI development and speed up the healing time. Urgo RID recently developed a new bilayer dressing to improve the healing of stages 2 and 3 heel PIs. This study aims to numerically investigate the efficiency of this new bilayer dressing to reduce strains around the PI site. METHODS The researchers designed three finite element models based on the same heel data set to compare the Green-Lagrange compressive and maximal shear strains in models without a PI, with a stage 2 PI, and with a stage 3 PI. Simulations with and without the dressing were computed. Analysis of the results was performed in terms of strain clusters, defined as volumes of tissues with high shear and compressive strains. RESULTS Decreases in the peak and mean values of strains were low in all three models, between 0% and 20%. However, reduction of the strain cluster volumes was high and ranged from 55% to 68%. CONCLUSIONS The cluster analysis enables the robust quantitative comparison of finite element analysis. Results suggest that use of the new bilayer dressing may reduce strain around the PI site and that this dressing could also be used in a prophylactic manner. Results should be extended to a larger cohort of participants.
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Affiliation(s)
- Nolwenn Fougeron
- Nolwenn Fougeron, PhD, is Postdoctoral Fellow, Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, Haifa, Israel. At the Laboratory TIMC (CNRS UMR5525), Université Grenoble Alpes, Saint-Martin-d'Hères, France, Gregory Chagnon, PhD, is Professor and Nathanael Connesson, PhD, and Thierry Alonso, PhD, are Associate Professors. Laurent Pasquinet, MScEng, and Stephane Auguste, MScEng, are Engineers, Urgo Research, Innovation, and Development, Paris, France. Also at the Laboratory TIMC, Antoine Perrier, PhD, is Professor and Yohan Payan, PhD, is Research Associate
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4
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Gefen A, Alves P, Beeckman D, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Swanson T, Woo K. Mechanical and contact characteristics of foam materials within wound dressings: Theoretical and practical considerations in treatment. Int Wound J 2022. [PMID: 36564958 DOI: 10.1111/iwj.14056] [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: 10/23/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
In the treatment of acute and chronic wounds, the clinical performance of a given foam-based dressing, and, ultimately, the wound healing and cost of care outcomes are strongly influenced by the mechanical performance of the foam material/s within that dressing. Most aspects of the mechanical performance of foam materials, for example, their stiffness, frictional properties, conformability, swelling characteristics and durability, and the overall mechanical protection provided by a foam-based dressing to a wound strongly depend on the microstructure of the foam components, particularly on their microtopography, density and porosity. This article, therefore, provides, for the first time, a comprehensive, self-inclusive compilation of clinically relevant theoretical and practical considerations, based on published analytical and experimental research as well as clinical experience related to the mechanical performance of foams in foam-based wound dressings. The current bioengineering information is useful for establishing understanding of the importance of mechanical properties of foams in foam-based dressings among clinicians and researchers in industry and academia, and other potential stakeholders in the wound care field, for example, regulators and buyers. This information is also particularly important for the development of standardised test methods for the evaluation of foam-based wound dressings and resulting standard mechanical performance metrics for these dressings.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Wounds Research Lab - Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | | | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Hospital Miller School of Medicine, Miami, Florida, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Terry Swanson
- Wound Education Research Consultancy (WERC), Warrnambool, Victoria, Australia
| | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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5
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Gefen A. Alternatives and preferences for materials in use for pressure ulcer prevention: An experiment-reinforced literature review. Int Wound J 2022; 19:1797-1809. [PMID: 35274443 DOI: 10.1111/iwj.13784] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022] Open
Abstract
Alleviation of localised, sustained tissue loads and microclimate management are the most critical performance criteria for materials in use for pressure ulcer prevention, such as in prophylactic dressings, padding or cushioning. These material performance criteria can be evaluated by calculating the extents of matching between the material stiffness (elastic modulus) and the thermal conductivity of the protective dressing, padding or cushioning with the corresponding properties of native skin, separately or in combination. Based on these bioengineering performance criteria, hydrocolloids, which are commonly used for prophylaxis of medical device-related pressure ulcers, exhibit poor stiffness matching with skin. In addition, there is remarkable variability in the modulus and thermal conductivity matching levels of different material types used for pressure ulcer prevention, however, it appears that among the materials tested, hydrogels provide the optimal matching with skin, followed by gels and silicone foams. The stiffness matching for hydrocolloids appears to be inferior even to that of gauze. This article provides quantitative performance criteria and metrics for these evaluations, and grades commonly used material types to biomechanically guide clinicians and industry with regards to the selection of dressings for pressure ulcer prevention, both due to bodyweight forces and as a result of applied medical devices.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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6
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Lustig M, Gefen A. The biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting prone surgical patients from chest injuries on the operating table. Int Wound J 2022; 19:1786-1796. [PMID: 35243764 PMCID: PMC9615289 DOI: 10.1111/iwj.13783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Pressure ulcers are soft‐tissue damage associated with tissue exposure to sustained deformations and stress concentrations. In patients who are proned for ventilation or surgery, such damage may occur in the superficial chest tissues that are compressed between the rib cage and the support surface. Prophylactic dressings have been previously proven as generally effective for pressure ulcer prevention. In this study, our goal was to develop a novel computational modelling framework to investigate the biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting proned surgical patients from chest pressure ulcers occurring on the operating table, due to body fixation by the Relton‐Hall frame. We compared the levels of mechanical compressive stresses developing in the soft chest tissues, above the sternum and ribs, due to the trunk weight, whilst the body is supported by the Relton‐Hall frame pads, with versus without the prophylactically applied bilateral dressings. The protective efficacy index for the extremely high stresses, above the 95th‐percentile, were 40.5%, 25.6% and 24.2% for skin, adipose and muscle, respectively, indicating that the dressings dispersed elevated soft‐tissue stresses. The current results provide additional support for using soft cellulose fluff core dressings for pressure ulcer prophylaxis, including during surgery.
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Affiliation(s)
- Maayan Lustig
- 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
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7
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Green C. Applying the Nightingale Pledge in Reducing Health Disparities: A Hospital-Acquired Pressure Injury Case Study. Adv Skin Wound Care 2022; 35:180-183. [PMID: 35188485 DOI: 10.1097/01.asw.0000815492.11595.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Professional nurses, by virtue of their training, pledge to care for individuals who are sick or infirm. This commitment is confirmed via the Nightingale Pledge, which focuses on public health and equity and deems the nurse to be a missioner of health. Health disparities exist in direct conflict with the nursing responsibility of caritas, or love. Accordingly, it is imperative that nurse educators create learning environments that are conducive to comfortably discussing differences in physical assessments performed on diverse populations as part of their work to eliminate health disparities and in accordance with the Nightingale Pledge.
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Affiliation(s)
- Cheryl Green
- Cheryl Green, PhD, DNP, RN, LCSW, CNL, CNE, ACUE, MAC, FAPA, is Associate Professor, Southern Connecticut State University, New Haven, Connecticut. The author has disclosed no financial relationships related to this article. Submitted March 16, 2021; accepted in revised form April 8, 2021
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8
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Lovegrove J, Fulbrook P, Miles S, Steele M. Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2022; 35:186-203. [PMID: 34144865 DOI: 10.1016/j.aucc.2021.04.007] [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: 01/28/2021] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. REVIEW METHOD USED This is a systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were searched in mid-2019. Searches were updated (in April 2020) to year end 2019. REVIEW METHODS From an overarching systematic review and meta-analysis examining the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings, trials conducted in intensive care were separated for an intensive care-specific synthesis. Two reviewers, with a third as an arbitrator, undertook study selection, data extraction, and risk-of-bias assessment. Included trials were grouped by intervention type for narrative synthesis and for random-effects meta-analysis using intention-to-treat data where appropriate. RESULTS Overall, 26 trials were included. Ten intervention types were found (support surfaces, prophylactic dressings, positioning, topical preparations, continence management, endotracheal tube securement, heel protection devices, medication, noninvasive ventilation masks, and bundled interventions). All trials, except one, were at high or unclear risk of bias. Four intervention types (endotracheal tube securement, heel protection devices, medication, and noninvasive ventilation masks) comprised single trials. Support surface trials were limited to type (active, reactive, seating, other). Meta-analysis was undertaken for reactive surfaces, but the intervention effect was not significant (risk ratio = 0.24, p = 0.12, I2 = 51%). Meta-analyses demonstrated the effectiveness of sacral (risk ratio = 0.22, p < 0.001, I2 = 0%) and heel (risk ratio = 0.31, p = 0.02; I2 = 0%) prophylactic dressings for pressure injury prevention. CONCLUSIONS Only prophylactic sacral and heel dressings demonstrated effectiveness in preventing pressure injury in adults admitted to intensive care settings. Further intensive care-specific trials are required across all intervention types. To minimise bias, we recommend that all future trials are conducted and reported as per relevant guidelines and recommendations.
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg, 2000, South Africa.
| | - Sandra Miles
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland, Australia 4014; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032.
| | - Michael Steele
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia 4032; School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, 1100 Nudgee Road, Banyo, Queensland, Australia 4014.
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9
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Grigatti A, Gefen A. The biomechanical efficacy of a hydrogel-based dressing in preventing facial medical device-related pressure ulcers. Int Wound J 2021; 19:1051-1063. [PMID: 34623741 PMCID: PMC9284629 DOI: 10.1111/iwj.13701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Continuous positive airway pressure masks for breathing assistance are used widely during the coronavirus pandemic. Nonetheless, these masks endanger the viability of facial tissues even after a few hours because of the sustained tissue deformations and extreme microclimate conditions. The risk of developing such device-related pressure ulcers/injuries can be reduced through suitable cushioning materials at the mask-skin interface, to alleviate localised contact forces. Here, we determined the facial tissue loading state under an oral-nasal mask while using hydrogel-based dressing cuts (Paul Hartmann AG, Heidenheim, Germany) for prophylaxis, which is a new concept in prevention of device-related injuries. For this purpose, we measured the compressive mask-skin contact forces at the nasal bridge, cheeks, and chin with vs without these dressing cuts and fed these data to a finite element, adult head model. Model variants were developed to compare strain energy densities and effective stresses in skin and through the facial tissue depth, with vs without the dressing cuts. We found that the dry (new) dressing cuts reduced tissue exposures to loads (above the median loading level) by at least 30% at the nasal bridge and by up to 99% at the cheeks, across the tissue depth. These dressing cuts were further able to maintain at least 65% and 89% of their protective capacity under moisture at the nasal bridge and cheeks, respectively. The hydrogel-based dressings demonstrated protective efficacy at all the tested facial sites but performed the best at the nasal bridge and cheeks, which are at the greatest injury risk.
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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
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10
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Margi R, Gefen A. Evaluation of facial tissue stresses under medical devices post application of a cyanoacrylate liquid skin protectant: An integrated experimental-computational study. Int Wound J 2021; 19:615-632. [PMID: 34402167 PMCID: PMC8874053 DOI: 10.1111/iwj.13660] [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: 04/09/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 12/21/2022] Open
Abstract
Medical device‐related pressure ulcers (PUs) (injuries) are a subclass of PUs, associated with pressure and/or shear applied by a medical device onto the skin. Clinical application of a cyanoacrylate liquid skin protectant (CLSP) under the contours of skin‐contacting medical devices to shield an intact skin from the sustained mechanical loads that are applied by medical devices is a preventative option, but no computer modelling work has been reported to assess the biomechanical efficacy of such interventions. Here, we investigated the biomechanical protective effect of a polymerised cyanoacrylate coating using three‐dimensional, anatomically realistic finite element models of the ear with oxygen cannula and the mouth with endotracheal attachment device, informed by experimental studies. We have compared tissue stress exposures under the devices at these facial sites between conditions where the cyanoacrylate skin protectant has been applied or where the device was contacting the skin directly, without the shielding of the cyanoacrylate coating. The CLSP considerably reduced the skin stress concentration levels and overall tissue stress exposures under the aforementioned medical devices. This demonstrates strong biomechanical effectiveness of the studied cyanoacrylate‐based skin protectant in prevention of facial medical device‐related injuries at small, curved and thereby difficult to protect facial sites.
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Affiliation(s)
- Raz Margi
- 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
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11
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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.
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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
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12
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Gefen A, Krämer M, Brehm M, Burckardt S. The biomechanical efficacy of a dressing with a soft cellulose fluff core in prophylactic use. Int Wound J 2020; 17:1968-1985. [PMID: 32869507 DOI: 10.1111/iwj.13489] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
In this work, we developed an experimental-computational analysis framework which facilitated objective, quantitative, standardised, methodological, and systematic comparisons between the biomechanical efficacies of two fundamentally different dressing technologies for pressure ulcer prevention: A dressing technology based on cellulose fibres used as the core matrix was evaluated vs the conventional silicone-foam dressing design concept, which was represented by multiple products which belong in this category. Using an anatomically-realistic computer (finite element) model of a supine female patient to whom the different sacral dressings have been applied virtually, we quantitatively evaluated the efficacy of the different dressings by means of a set of 3 biomechanical indices: The protective efficacy index, the protective endurance, and the prophylactic trade-off design parameter. Prior rigorous experimental measurements of the physical and mechanical behaviours and properties of each tested dressing, including tensile, compressive, and friction properties, have been conducted and used as inputs for the computer modelling. Each dressing was evaluated for its tissue protection performances at a new (from the package) state, as well as after exposure to moisture conditions simulating wet bedsheets. Our results demonstrated that the dressing with the fluff core is at least as-good as silicone-foams but importantly, provides the best balance between protective performances at its "new" condition and the performance after being exposed to moisture. We conclude that preventative dressings are not equal in their prophylactic performances, but rather, the base technology, the ingredients, and their arrangement in the dressing structure shape the quality of the delivered tissue protection.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Maja Krämer
- Paul Hartmann AG, Wound Management Development Technology Platforms, Germany
| | - Maik Brehm
- Merkle & Partner GbR - Ingenieurbüro für Simulation und Entwicklung, Germany
| | - Sören Burckardt
- Merkle & Partner GbR - Ingenieurbüro für Simulation und Entwicklung, Germany
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