Altered skin blood perfusion in areas with non blanchable erythema: an explorative study

Abstract

Non blanchable erythema, i.e. stage I pressure ulcer, is common in patients in acute and geriatric care and in nursing homes. Research has shown that this type of lesions is prone to develop into more severe pressure ulcers. The peripheral skin blood perfusion is of major importance for the development of pressure ulcers. The aim of this study was to explore the peripheral skin blood perfusion over time, in areas with non blanchable erythema and in corresponding undamaged areas on the opposite side of the body. A total of 19 measurements were performed, over time, using a laser Doppler perfusion imager. The blood flow distribution profiles over areas with non blanchable erythema and undamaged skin were found to be different. As the area of the non blanchable erythema decreased, the blood perfusion distribution profiles gradually became more heterogeneous; an area of high blood perfusion in the centre of the lesions was seen and the perfusion successively decreased closer to the edge. These results indicate that there are differences in blood perfusion between skin areas of non blanchable erythema and undamaged skin. The results also indicate that the visible redness in areas with non blanchable erythema is related to altered blood perfusion. The skin blood perfusion also seems to increase in relation to the size of the non blanchable erythema.

Complex Wounds

“…In this context, we come across pressure wounds, also known as pressure sores which represent a significant challenge for health professionals. 57,58 A pressure sore is defined as an area of necrosis in the integument developed as a result of compression of soft tissues between an osseous prominence and a hard surface during a sufficiently long period of time to induce local ischemia. 59 Patients with pressure sores have extended dependency on their caretakers, higher mortality, and lower quality of life.…”

A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths

“…The assessment of blood flow has several important applications, such as during the healing of burn injuries [21,29], transplantation of skin flaps [16], arteriogenesis [6] and investigations of pressure ulcers [20]; however, the methods need to be refined to also allow the discrimination of blood flow in different vascular beds.…”

Category I Pressure Ulcers How Reliable Is Clinical Assessment?

“…It can be difficult to relieve the pressure for long enough before assessing the skin, both before and after hip surgery. If several periods of prolonged persistent redness occur, it can take several days before the skin begins to break down or, alternatively, before it can resolve to normal tissue (Bliss 1998a;Lindgren et al, 2006;Witkowski & Parish, 2000). To achieve an optimal assessment of skin condition, it is considered important to relieve pressure before erythema is assessed.…”

“…As pressure is released, a rush of incoming arterial blood, commonly known as reactive hyperemia, occurs (Bliss, 1998a;Kosiak, 1959;Lewis & Grant, 1925;Shea, 1975). If the skin blanches with light finger pressure (blanching hyperemia), then the patient's microcirculation is said to be intact (Bliss, 1998a;Kosiak, 1959;Lindgren, Malmqvist, Sjoberg, & Ek, 2006;Shea, 1975); however, it is impossible to truly determine whether microcirculation is intact since present test methods are subjective and depend on the assessor's experience, the lighting conditions, and the skin color of the patient. Blanching hyperemia is a normal response in healthy individuals that allows the microcirculation to deliver oxygen and remove metabolites after periods of peripheral capillary occlusion.…”