Cytoskeleton and plasma-membrane damage resulting from exposure to sustained deformations: A review of the mechanobiology of chronic wounds

Gefen, Amit; Weihs, Daphne

doi:10.1016/j.medengphy.2016.05.014

Cited by 54 publications

(45 citation statements)

References 59 publications

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“…These findings have not been seen in previous research in this area and are of particular interest because of the current discussion in the field related to the pathophysiology of DTI and PrI development. Specifically, the findings that DTI SEM values were lower than normal skin suggest that the pathophysiology model of "bottom to top" damage where damage begins at inner tissue levels and progresses up to the skin 19,50,51 may be involved in DTI development. As tissue cells die and become non-viable, the necrotic area is not perfused and has decreased blood flow.…”

Section: Discussionmentioning

confidence: 99%

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes

Bates‐Jensen

McCreath

Nakagami

et al. 2017

International Wound Journal

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We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI.

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Section: Discussionmentioning

confidence: 99%

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes

Bates‐Jensen

McCreath

Nakagami

et al. 2017

International Wound Journal

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“…Multiple model systems, including MRI of human subjects, animal models, tissue‐engineered constructs, and cell culture models facilitating the application of sustained, controlled deformations to tissues and cells, have highlighted the role of direct deformation damage to cells . Specifically, recent published experimental evidence demonstrates that poration of the plasma membrane caused by the sustained deformations interferes with transport processes that normally occur through the plasma membrane and, thereby, causes loss of homeostasis (biological equilibrium) . Moreover, these model systems altogether identified the short time frames at which damage to cells is inflicted, which is in the order of tens of minutes and much faster than the previously assumed ischaemic damage cascade, which takes several hours to develop …”

Section: The Role Of Tissue Deformation In the Pathogenesis Of Pressumentioning

confidence: 99%

“…At the microscopic scale, the chronic distortion of cells causes disruption of the cytoskeleton, which, especially in the lack of available energy, gradually loses its capacity of structurally supporting the plasma membrane . As indicated above, this leads to the formation of nanometre‐wide openings (pores), which form in the plasma membrane of the distorted cells.…”

Section: The Role Of Tissue Deformation In the Pathogenesis Of Pressumentioning

confidence: 99%

“…These mechanically (and sometimes biochemically) stressed cells are typically unable to repair the poration. Hence, fluxes of biomolecules and ions penetrate the cell bodies and/or escape cells uncontrollably, eventually causing the loss of homeostasis in the cells and resulting in apoptotic cell death in growing cell numbers . Inflammation develops consequently; however, older ED patients with background diseases such as diabetes or immunodeficiency syndrome that affect the inflammatory response may, depending on the individual patient conditions and severity, develop an abnormal, hypo‐, or hyper‐inflammatory response, and either state can contribute to the damage spiral within tissues.…”

Section: The Role Of Tissue Deformation In the Pathogenesis Of Pressumentioning

confidence: 99%

“…27 Specifically, recent published experimental evidence demonstrates that poration of the plasma membrane caused by the sustained deformations interferes with transport processes that normally occur through the plasma membrane and, thereby, causes loss of homeostasis (biological equilibrium). [24][25][26] Moreover, these model systems altogether identified the short time frames at which damage to cells is inflicted, which is in the order of tens of minutes and much faster than the previously assumed ischaemic damage cascade, which takes several hours to develop. 21,27 At the microscopic scale, the chronic distortion of cells causes disruption of the cytoskeleton, which, especially in the lack of available energy, gradually loses its capacity of structurally supporting the plasma membrane.…”

Section: Key Messagesmentioning

confidence: 99%

See 2 more Smart Citations

Preventing pressure injuries in the emergency department: Current evidence and practice considerations

Santamaria

Creehan

Fletcher³

et al. 2019

International Wound Journal

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The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence‐based PI prevention protocols for the high‐risk emergency/trauma patient. The prevention of hospital‐acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence‐based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.

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Pressure Injury and Pressure Ulcers

Haesler,

Kottner

2024

Rook's Textbook of Dermatology

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Pressure ulcers are defects of the skin and/or underlying tissues that occur because of pressure or pressure in combination with shear. Pressure ulcers occur due to prolonged exposure to mechanical load that increases internal stresses and strains. Some individuals are at increased risk of developing a pressure ulcer, particularly those who are immobile. Identifying those at risk and implementing preventive strategies that address these risks are an imperative. When a pressure ulcer occurs, accurate assessment of the extent of skin and underlying tissue damage and the clinical condition of the ulcer assists in selection of appropriate wound treatments. This chapter provides an overview of the epidemiology and pathophysiology of pressure ulcers, their classification and assessment, and strategies that are used in their prevention and treatment.

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Cytoskeleton and plasma-membrane damage resulting from exposure to sustained deformations: A review of the mechanobiology of chronic wounds

Cited by 54 publications

References 59 publications

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes

Preventing pressure injuries in the emergency department: Current evidence and practice considerations

Pressure Injury and Pressure Ulcers

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