Cellular Deformations under Compression in Cells Involved in Deep Tissue Injury

Risk Factors for Pressure Ulcers Including Suspected Deep Tissue Injury in Nursing Home Facility Residents

“…3 Because of the increasing occurrence and severity of PrUs, in 2007 the National Pressure Ulcer Advisory Panel revised the classifications of the 4 stages of PrU (I, II, III, and IV) and added 2 more classifications: Bunstageable[ and Bsuspected deep tissue injury[ (sDTI). 4,5 This internal injury originates in the muscular tissue that overlies bony prominences as a result of soft tissue (skeletal muscle and fat tissues) deformations and progresses outward 6 until it appears on the skin surface as a purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. 4,5 The second type, sDTI, is due to a pressure-related injury under intact skin.…”

“…5 The area may be preceded by tissue that is painful, firm, mushy, boggy, or warmer or cooler as compared with adjacent tissue. 6,11 Prior research has focused on ischemic/hypoxic damage, ischemia-reperfusion injury, structural damage to cells, and interference with lymphatic and interstitial fluid drainage. Evolution may include a thin blister over a dark wound bed.…”

“…Suspected DTI may be difficult to detect in individuals with dark skin tones. 6 However, recent studies by Slomka et al 6 have shown that the involvement of sustained deformation-related events at the cellular level is directly responsible for the distortion of cells, the deformation of plasma membranes leading to increased membrane permeability, impairment of cellular control mechanisms, and eventual cell death caused by loss of cell homeostasis leading to sDTI. These serious wounds may further evolve and be covered by thin eschar.…”