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Tatsuta K, Sakata M, Sugiyama K, Kojima T, Akai T, Suzuki K, Torii K, Morita Y, Kikuchi H, Hiramatsu Y, Kurachi K, Takeuchi H. Impact of shear stress on sacral pressure injury from table rotation during laparoscopic colorectal surgery performed in the lithotomy position. Sci Rep 2024; 14:9748. [PMID: 38679609 PMCID: PMC11056377 DOI: 10.1038/s41598-024-60424-9] [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: 07/04/2023] [Accepted: 04/23/2024] [Indexed: 05/01/2024] Open
Abstract
This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy position. We included 37 patients who underwent this procedure between November 2021 and October 2022. The primary outcome was average horizontal shear stress caused by the rotation of the operating table during the operation, and the secondary outcome was interface pressure over time. Sensors were used to measure shear stress and interface pressure in the sacral region. Patients were divided into two groups according to the presence or absence of PI. PI had an incidence of 32.4%, and the primary outcome, average horizontal shear stress, was significantly higher in the PI group than in the no-PI group. The interface pressure increased over time in both groups. At 120 min, the interface pressure was two times higher in the PI group than in the no-PI group (PI group, 221.5 mmHg; no-PI group, 86.0 mmHg; p < 0.01). This study suggested that shear stress resulting from rotation of the operating table in the sacral region by laparoscopic colorectal surgery performed in the lithotomy position is the cause of PI. These results should contribute to the prevention of PI.
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Affiliation(s)
- Kyota Tatsuta
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mayu Sakata
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Kosuke Sugiyama
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tadahiro Kojima
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsunori Suzuki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kakeru Torii
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Tahara Y, Amemiya A, Kase R, Kitagawa Y, Ogasawara S, Kato N, Komiyama M. Relationship between hand-foot skin reaction and external force on patients with hepatocellular carcinoma: A cohort study. Eur J Oncol Nurs 2024; 70:102576. [PMID: 38642523 DOI: 10.1016/j.ejon.2024.102576] [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: 09/21/2022] [Revised: 02/17/2024] [Accepted: 03/20/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Hand-foot skin reaction (HFSR), a side effect of tyrosine kinase inhibitor (TKI) treatment, makes it difficult to walk and perform daily activities because of pain in the limbs. HFSR occurs predominantly in the sites where external forces (pressure and shear stress) are applied. This study aimed to determine whether pressure or shear stress induces the occurrence of HFSR. METHODS This cohort study was conducted in patients who received TKI treatment for hepatocellular carcinoma. The external forces applied to the sole of the patients' foot while walking was measured, and its association with the occurrence of HFSR was examined. The degree of HFSR was assessed by the patient's response during the examination and by photographs of their feet. The patients' feet were divided into low (grade <2) or high (grade ≥2) HFSR foot group, and the differences in external forces between the groups were analyzed using t-test and Cox hazard analysis. RESULTS Analysis of the feet of 55 study participants (n = 110) showed no significant difference between the groups on t-test (p ≥ 0.05), however, Cox hazard analysis showed an increased risk of HFSR with higher peak shear stress values at the fifth metatarsal head (hazard ratio = 1.01, p = 0.047; 95% confidence interval = 1.00-1.02). CONCLUSION Shear stress is possibly related to HFSR occurrence. Nurses should assess whether patients' shoes fit their feet before initiating TKI treatment. They should instruct patients to wear shoes that are fit of both diameter and width for their feet.
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Affiliation(s)
- Yukie Tahara
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan.
| | - Ayumi Amemiya
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Ryutaro Kase
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Yuka Kitagawa
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masatoshi Komiyama
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
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Calik J, Pilarski B, Migdał M, Sauer N. Assessing Excessive Keratinization in Acral Areas through Dermatoscopy with Cross-Polarization and Parallel-Polarization: A Dermatoscopic Keratinization Scale. J Clin Med 2023; 12:7077. [PMID: 38002691 PMCID: PMC10671891 DOI: 10.3390/jcm12227077] [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: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Excessive epidermal hyperkeratosis in acral areas is a common occurrence in dermatology practice, with a notable prevalence of approximately 65% in the elderly, especially in plantar lesions. Hyperkeratosis, characterized by thickening of the stratum corneum, can have various causes, including chronic physical or chemical factors, genetic predispositions, immunological disorders, and pharmaceutical compounds. This condition can significantly impact mobility, increase the risk of falls, and reduce the overall quality of life, particularly in older individuals. Management often involves creams containing urea to soften hyperkeratotic areas. Currently, subjective visual evaluation is the gold standard for assessing hyperkeratosis severity, lacking precision and consistency. Therefore, our research group proposes a novel 6-point keratinization scale based on dermatoscopy with cross-polarization and parallel-polarization techniques. This scale provides a structured framework for objective assessment, aiding in treatment selection, duration determination, and monitoring disease progression. Its clinical utility extends to various dermatological conditions involving hyperkeratosis, making it a valuable tool in dermatology practice. This standardized approach enhances communication among healthcare professionals, ultimately improving patient care and research comparability in dermatology.
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Affiliation(s)
- Jacek Calik
- Old Town Clinic, 50-043 Wroclaw, Poland;
- Department of Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | | | | | - Natalia Sauer
- Old Town Clinic, 50-043 Wroclaw, Poland;
- Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wrocław, Poland
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Sánchez-Rodríguez R, Martínez-Quintana R, Martínez-Nova A, Martínez-Rico M, Pedrera-Zamorano JD, Chicharro-Luna E. Correlation between the foot pressure index and the prevalence of plantar hyperkeratosis. J Tissue Viability 2023:S0965-206X(23)00064-5. [PMID: 37268490 DOI: 10.1016/j.jtv.2023.05.007] [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: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Plantar hyperkeratosis (HK) is a very prevalent foot lesion formed due to an alteration in the keratinisation process, thereby increasing keratynocites and accumulating multiple layers of the stratum corneum that leads to plantar pain. As foot shape and plantar pressures is related with their appearance, the aim of this study is to examine how foot posture and plantar pressure influence the appearance of this keratopathy. MATERIAL AND METHODS On a sample of 400 subjects (201 men and 199 women), the plantar pressures were evaluated by the Footscan® platform in 10 zones. The clinical exploration consisted in the valuation of the Foot Posture Index (FPI), and the assessment of the appeerance (and location) or not of plantar calluses or hyperkeratosis. RESULTS 6.3% of the feet presented a highly supinated FPI, 15.5% were supinated, 57.3% corresponded to neutral, 17.3% were pronated and 3.8% were highly pronated. The participants with HK on the hallux, on the 1st, 2nd, 3rd or 5th MTH or on the lateral heel had a significantly higher pressure index (p < 0.001), ranging from 24.3 to 44% higher than those with no such alteration. Of the highly pronated feet, 66.7% presented HK in the hallux, while 32.3% of the supinated feet and 60% of the highly supinated feet presented it beneath the first MTH. CONCLUSION Foot posture influences the appearance of HK, though its association with plantar pressures. The participants with HK presented a mean foot pressure that was 32.3% higher than in those with no such condition. These values can be considered predictive for the appearance of HK and should be indicative of the need for preventive treatment.
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Affiliation(s)
| | | | - Alfonso Martínez-Nova
- Department of Nursing. Podiatry. University of Extremadura, Plasencia (Cáceres), Spain.
| | - Magdalena Martínez-Rico
- Department of Nursing and Podiatry. Faculty of Health Sciences, University of Málaga Málaga, Spain
| | | | - Esther Chicharro-Luna
- Department of Behavioural Sciences and Health, Miguel Hernández University, San Juan de Alicante, Spain
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Tashiro S, Gotou N, Oku Y, Sugano T, Nakamura T, Suzuki H, Otomo N, Yamada S, Tsuji T, Asato Y, Ishii N. Relationship between Plantar Pressure and Sensory Disturbance in Patients with Hansen's Disease-Preliminary Research and Review of the Literature. SENSORS 2020; 20:s20236976. [PMID: 33291332 PMCID: PMC7730212 DOI: 10.3390/s20236976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022]
Abstract
Orthoses and insoles are among the primary treatments and prevention methods of refractory plantar ulcers in patients with Hansen’s disease. While dynamic plantar pressure and tactile sensory disturbance are the critical pathological factors, few studies have investigated whether a relationship exists between these two factors. In this study, dynamic pressure measured using F-scan system and tactile sensory threshold evaluated with monofilament testing were determined for 12 areas of 20 feet in patients with chronic Hansen’s disease. The correlation between these two factors was calculated for each foot, for each clinical category of the foot (0–IV) and across all feet. A significant correlation was found between dynamic pressure and tactile sensation in Category II feet (n = 8, p = 0.016, r2 = 0.246, Spearman’s rank test). In contrast, no significant correlation was detected for the entire foot or within the subgroups for the remainder of the clinical categories. However, the clinical manifestation of lesion areas showed high variability: (1) pressure concentrated, sensation lost; (2) margin of pressure concentration, sensation lost; (3) pressure concentrated, sensation severely disturbed but not lost; and (4) tip of the toe. These results may indicate that, even though there was a weak relationship between dynamic pressure and tactile sensation, it is important to assess both, in addition to the basics of orthotic treatment in patients with Hansen’s disease presenting with refractory plantar ulceration.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan;
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan;
- Correspondence: ; Tel.: +81-3-5363-3833
| | - Naoki Gotou
- Department of Prosthesis and Orthosis, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (N.G.); (T.S.)
| | - Yuki Oku
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
- Department of Rehabilitation, National Hospital Organization Tokyo Hospital, Kiyose, Tokyo 204-8585, Japan
| | - Takahiro Sugano
- Department of Prosthesis and Orthosis, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (N.G.); (T.S.)
| | - Takuya Nakamura
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan;
| | - Hiromi Suzuki
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
| | - Nao Otomo
- Department of Orthopaedic Surgery, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan;
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan;
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan;
| | - Yutaka Asato
- Department of Surgery, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan;
| | - Norihisa Ishii
- Department of Dermatology, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan;
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Kaneko F, Edama M, Ikezu M, Matsuzawa K, Hirabayashi R, Kageyama I. Anatomic Characteristics of Tissues Attached to the Fifth Metatarsal Bone. Orthop J Sports Med 2020; 8:2325967120947725. [PMID: 32995346 PMCID: PMC7503013 DOI: 10.1177/2325967120947725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Two types of stress, bending stress and traction stress, have been reported to be involved in the mechanism of Jones fracture. However, little is known about the risk factors for traction stress. Purpose To classify the attachment position of the peroneus brevis muscle (PB), peroneus tertius (PT), lateral band of the plantar aponeurosis (LB), and the long plantar ligament (LPL), focusing on the zone where a Jones fracture occurs (zone 2), and to compare the footprint area of each tissue type. Study Design Descriptive laboratory study. Methods This study examined 102 legs from 55 Japanese cadavers. Type classification was performed by focusing on the positional relationship between each tissue attachment and the zone where Jones fracture occurs (zone 2). The classifications were as follows: type I, attached proximal to the border between zones 1 and 2; type IIa, attached to the border between zones 1 and 2 with one attached part; and type IIb, attached across the border between zones 1 and 2 with two or more attached parts. The footprint areas of the PB, PT, LB, and LPL were compared between tissue types and within each attachment classification. Results The PB was recorded as type I in 41 feet (40.2%), type IIa in 56 feet (54.9%), and type IIb in 5 feet (4.9%); the PT was recorded as type IIa in 54 feet (60.0%) and type IIb in 36 feet (40.0%); and the LB was recorded as type I in 27 feet (26.5%) and type IIa in 75 feet (73.5%). The LPL did not attach to the fifth metatarsal bone. No significant difference was found in the footprint area between type I PB and type I LB. Conclusion The results indicate that type I, which attaches proximal to zone 2, occurs with PB and LB, and there was no significant difference in the footprint area between them. These findings suggest that type I is involved in traction stress. In the future, biomechanical research based on the results of this study will be necessary. Clinical Relevance The results of this study provide basic research for investigating the mechanism of Jones fracture and the cause of delayed healing.
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Affiliation(s)
- Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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Jones PJ, Bibb RJ, Davies MJ, Khunti K, McCarthy M, Fong DTP, Webb D. A fitting problem: Standardising shoe fit standards to reduce related diabetic foot ulcers. Diabetes Res Clin Pract 2019; 154:66-74. [PMID: 31128134 DOI: 10.1016/j.diabres.2019.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022]
Abstract
AIMS Incorrectly fitting shoes are implicated in callus formation and a significant proportion of diabetic foot ulcers, yet remain surprisingly prevalent. We review the current shoe fit guidelines for consistency and discuss ways in which technology may assist us in standardising methods of footwear assessment. METHODS Narrative review. RESULTS Incorrectly fitted shoes are implicated in the development of some diabetic foot ulcers yet surprisingly there's no consensus on shoe fit, despite substantial spending on prescription footwear. Suggested toe gaps vary from 6 to 20 mm and measurement methods also vary from Brannock Devices and callipers to manual measurement. CONCLUSIONS To prevent fit-related foot ulceration, we need to standardise our biomechanical definition of fit. Future research should (1) evaluate the potential use of 3D scanning technology to provide a standardised means of capturing foot morphology; (2) develop a working biomechanical definition of fit, including toe gap through the identification of key physiological markers that capture and predict dynamic foot shape changes during different physical activities and body weight loading conditions; and (3) determine whether changes in dynamic foot shape of those with diabetes differs from those without, impacting on their shoe fitting needs, potentially necessitating specialist footwear at an earlier stage to avoid ulceration.
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Affiliation(s)
- Petra J Jones
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - Richard J Bibb
- Loughborough Design School, Loughborough University, Loughborough, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Matthew McCarthy
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Daniel T P Fong
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - David Webb
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
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