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Gordon RJFH, Worsley PR, Filingeri D. An evaluation of the effects of localised skin cooling on microvascular, inflammatory, structural, and perceptual responses to sustained mechanical loading of the sacrum: A study protocol. PLoS One 2024; 19:e0303342. [PMID: 38728306 PMCID: PMC11086830 DOI: 10.1371/journal.pone.0303342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
This study protocol aims to investigate how localised cooling influences the skin's microvascular, inflammatory, structural, and perceptual tolerance to sustained mechanical loading at the sacrum, evaluating factors such as morphology, physiology, and perceptual responses. The protocol will be tested on individuals of different age, sex, skin tone and clinical status, using a repeated-measure design with three participants cohorts: i) young healthy (n = 35); ii) older healthy (n = 35); iii) spinal cord injured (SCI, n = 35). Participants will complete three testing sessions during which their sacrum will be mechanically loaded (60 mmHg; 45 min) and unloaded (20 min) with a custom-built thermal probe, causing pressure-induced ischemia and post-occlusive reactive hyperaemia. Testing sessions will differ by the probe's temperature, which will be set to either 38°C (no cooling), 24°C (mild cooling), or 16°C (strong cooling). We will measure skin blood flow (via Laser Doppler Flowmetry; 40 Hz); pro- and anti-inflammatory biomarkers in skin sebum (Sebutape); structural skin properties (Optical Coherence Tomography); and ratings of thermal sensation, comfort, and acceptance (Likert Scales); throughout the loading and unloading phases. Changes in post-occlusive reactive hyperaemia will be considered as the primary outcome and data will be analysed for the independent and interactive effects of stimuli's temperature and of participant group on within- and between-subject mean differences (and 95% Confidence Intervals) in peak hyperaemia, by means of a 2-way mixed model ANOVA (or Friedman). Regression models will also be developed to assess the relationship between absolute cooling temperatures and peak hyperaemia. Secondary outcomes will be within- and between-subject mean changes in biomarkers' expression, skin structural and perceptual responses. This analysis will help identifying physiological and perceptual thresholds for the protective effects of cooling from mechanically induced damage underlying the development of pressure ulcers in individuals varying in age and clinical status.
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Affiliation(s)
- Ralph J. F. H. Gordon
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Peter R. Worsley
- PressureLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Davide Filingeri
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
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Russell LJ, Dodd T, Kendall D, Lazenbury A, Leggett A, Payton-Haines S, Jiang L, Filingeri D, Worsley PR. A bioengineering investigation of cervical collar design and fit: Implications on skin health. Clin Biomech (Bristol, Avon) 2024; 112:106178. [PMID: 38232471 DOI: 10.1016/j.clinbiomech.2024.106178] [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: 08/30/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Cervical collars restrict cervical spine movement to minimise the risk of spinal cord injury. Collars apply mechanical loading to the skin putting it at risk of skin damage. Indeed, cervical collar-related pressure ulcers are unacceptably prevalent, especially at the occiput, mandibles, and chin. Collar design and fit are often key considerations for prevention. METHODS This comprehensive study evaluated four commercial prehospital and acute care cervical collars. Pressure, microclimate, transepidermal water loss and skin hydration were measured at the interface between the device and the skin. Range of motion restriction was measured to evaluate effective immobilisation. Head, neck, and shoulder morphology was evaluated using three-dimensional scans. FINDINGS The occiput experienced significantly higher interface pressures than the chin and mandibles for most collar designs. Interface pressure at the occiput was significantly higher for the Stiffneck extrication collar compared to the other collar designs. The Stiffneck collar also provided the most movement restriction, though not significantly more than other designs. Relative humidity at the device skin interface was significantly higher for the Stiffneck and Philadelphia collars corresponding to closed cell foam padding, in contrast to the open cell foams lined with permeable fabric used in the other collars. Collar discomfort correlated with both occipital pressure and skin humidity. INTERPRETATION The occiput is at increased risk of cervical collar-related pressure ulcers during supine immobilisation, especially for Stiffneck extrication collars. Lined open-cell foams could be used to minimise skin humidity and increase comfort.
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Affiliation(s)
- Laurence J Russell
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Tamara Dodd
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Daniel Kendall
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Amber Lazenbury
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Abigail Leggett
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Sophie Payton-Haines
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Davide Filingeri
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Valenza A, Rykaczewski K, Martinez DM, Bianco A, Caggiari S, Worsley P, Filingeri D. Thermal modulation of skin friction at the finger pad. J Mech Behav Biomed Mater 2023; 146:106072. [PMID: 37597311 DOI: 10.1016/j.jmbbm.2023.106072] [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: 02/23/2023] [Revised: 04/25/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
Preliminary human studies show that reduced skin temperature minimises the risk of mechanically induced skin damage. However, the mechanisms by which cooling enhances skin tolerance to pressure and shear remain poorly understood. We hypothesized that skin cooling below thermo-neutral conditions will decrease kinetic friction at the skin-material interface. To test our hypothesis, we measured the friction coefficient of a thermally pre-conditioned index finger pad sliding at a normal load (5N) across a plate maintained at three different temperatures (38, 24, and 16 °C) in 8 healthy young adults (29±5y). To quantify the temperature distribution of the skin tissue, we used 3D surface scanning and Optical Coherence Tomography to develop an anatomically representative thermal model of the finger. Our group-level data indicated that the sliding finger with thermally affected tissues (up to 8 mm depth) experienced significantly lower frictional forces (p<0.01) at plate temperatures of 16 °C (i.e. 32% decrease) and 24 °C (i.e. 13% decrease) than at 38 °C, respectively. This phenomenon occurred consistently across participants (i.e. N = 6/8, 75%) and without large changes in skin hydration during sliding. Our complementary experimental and theoretical results provide new insights into thermal modulation of skin friction that can be employed for developing thermal technologies to maintain skin integrity under mechanical loading and shearing.
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Affiliation(s)
- Alessandro Valenza
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, UK; Sport and Exercise Sciences Research Unit, SPPEFF Department, University of Palermo, Italy
| | - Konrad Rykaczewski
- School for Engineering of Matter, Transport and Energy, Arizona State University, 501 E Tyler Mall, Tempe, AZ, 85287, USA; Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Tempe, AZ, 85287, USA
| | - Daniel M Martinez
- School for Engineering of Matter, Transport and Energy, Arizona State University, 501 E Tyler Mall, Tempe, AZ, 85287, USA
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, SPPEFF Department, University of Palermo, Italy
| | - Silvia Caggiari
- PressureLab, Skin Sensing Research Group, School of Health Science, University of Southampton, UK
| | - Peter Worsley
- PressureLab, Skin Sensing Research Group, School of Health Science, University of Southampton, UK
| | - Davide Filingeri
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, UK.
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Nasir NJM, Heemskerk H, Jenkins J, Hamadee NH, Bunte R, Tucker-Kellogg L. Myoglobin-derived iron causes wound enlargement and impaired regeneration in pressure injuries of muscle. eLife 2023; 12:85633. [PMID: 37267120 DOI: 10.7554/elife.85633] [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: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/04/2023] Open
Abstract
The reasons for poor healing of pressure injuries are poorly understood. Vascular ulcers are worsened by extracellular release of hemoglobin, so we examined the impact of myoglobin (Mb) iron in murine muscle pressure injuries (mPI). Tests used Mb-knockout or treatment with deferoxamine iron chelator (DFO). Unlike acute injuries from cardiotoxin, mPI regenerated poorly with a lack of viable immune cells, persistence of dead tissue (necro-slough), and abnormal deposition of iron. However, Mb-knockout or DFO-treated mPI displayed a reversal of the pathology: decreased tissue death, decreased iron deposition, decrease in markers of oxidative damage, and higher numbers of intact immune cells. Subsequently, DFO treatment improved myofiber regeneration and morphology. We conclude that myoglobin iron contributes to tissue death in mPI. Remarkably, a large fraction of muscle death in untreated mPI occurred later than, and was preventable by, DFO treatment, even though treatment started 12 hr after pressure was removed. This demonstrates an opportunity for post-pressure prevention to salvage tissue viability.
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Affiliation(s)
- Nurul Jannah Mohamed Nasir
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Hans Heemskerk
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
- BioSyM and CAMP Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, CREATE, Singapore, Singapore
| | - Julia Jenkins
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | | | - Ralph Bunte
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Lisa Tucker-Kellogg
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
- BioSyM and CAMP Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, CREATE, Singapore, Singapore
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McLaren-Kennedy A, Chaboyer W, Thalib L, Latimer S. The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study. J Tissue Viability 2023; 32:2-8. [PMID: 36732157 DOI: 10.1016/j.jtv.2023.01.009] [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: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Subepidermal moisture (SEM) changes may detect early tissue injury and enhance pressure injury risk assessments. However, little is known how modifiable factors, like head of bed elevation (HOBE), affect SEM. AIM This study investigated the influence of HOBE on sacral and heel SEM, using the Provizio ® SEM Scanner. METHOD A 2 × 2 randomised crossover study compared the effects of 30-min of 30⁰ versus 60⁰ HOBE on sacral and heel SEM in healthy adults. RESULTS 48 participants were randomly allocated to 30⁰ or 60⁰ HOBE and crossed over after a 60-min washout period. The mean age was 40.6 years (SD = 18.3). The study found the sacral and heel SEM values were not statistically different at 30⁰ versus 60⁰ HOBE. No clinically relevant association between SEM and characteristics of age, sex, body mass index and skin type were found. Baseline sacral and heel SEM values recovered after a 60-min washout period. Notably, half of the initial baseline measures suggested pressure injury risk. CONCLUSION The HOBE may not influence SEM at the sacrum and heels, in healthy adults after 30 min of loading. Standard operating procedures for measuring SEM for pressure injury risk assessment require a stronger body of evidence in varied populations and timeframes before this technology is widely adopted. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622001456741.
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Affiliation(s)
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland and School of Nursing and Midwifery Griffith University, Gold Coast, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland and School of Nursing and Midwifery Griffith University, Gold Coast, Australia
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Van Asten JGMV, Fung MT, Oomens CWJ, Bader DL, Worsley PR. A combined experimental and computational approach to evaluate microclimate control at the support surface interface. J Tissue Viability 2021; 30:395-401. [PMID: 34030943 DOI: 10.1016/j.jtv.2021.04.007] [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: 12/17/2020] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
Temperature and humidity conditions at the interface between a support surface and the skin, termed microclimate, has been implicated in the development of pressure ulcers. Support surface technologies have been developed to control microclimate conditions, although only a few standard test methods exist to evaluate their performance. This study describes a combined experimental-computational approach to analyzing microclimate control systems. The study used a modified physical model protocol to evaluate two specific support surface systems involving a spacer fabric cover with i) no air flow and ii) an active fan. The physical model deposited moisture at a controlled rate for 25 min, and the microclimate conditions under the model and the surrounding area were monitored for 24 h. Using the experimental data as boundary conditions, a finite element model was developed using mass transport principles, which was calibrated using experimental results. Model inputs included mass density and mass diffusivity, resulting in an estimated absolute humidity change over time. The physical model tests revealed distinct differences between the support surfaces with and without active airflow, with the former having little effect on local humidity levels (RH>75% for 24hr). By contrast, there was a spatial and temporal change in microclimate with the active fan, with sensors positioned towards the source of airflow reaching ambient conditions within 24hr. The computational model was refined to produce comparable results with respect to both the spatial distribution of microclimate and the change in values over time. The combined experimental and computation approach was able to distinguish distinct difference in microclimate change between two support surface designs. The approach could enable the efficient evaluation of different mattress design principles to aid decision making for personalized support surface solutions, for the prevention of pressure ulcers.
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Affiliation(s)
- J G M V Van Asten
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - M-T Fung
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - C W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - D L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - P R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK.
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