Morphological Characteristics of the Dermal Papillae in the Development of Pressure Sores

Arao, Hiromi; Obata, Mitsuko; Shimada, Toshio; Hagisawa, Satsue

doi:10.1016/s0965-206x(98)80042-9

Cited by 25 publications

(19 citation statements)

References 6 publications

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“…These findings are consistent with imaging and biochemical research. Using scanning electron microscopy, Arao et al observed morphological changes to the dermal papillae and collagen fibres suggestive of impaired micro‐circulation at the border of a Stage II pressure ulcer as compared with healthy and undamaged areas. In healthy tissue, the papillary layer is the site of oxygen and nutrient transfer to the epidermis and is critical for maintaining skin integrity.…”

Section: The Spatial Distribution Of Damage In Pressure Ulcersmentioning

confidence: 99%

Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure‐induced tissue damage (pressure ulcers)

Moore

Patton

Rhodes

et al. 2016

International Wound Journal

101

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Current detection of pressure ulcers relies on visual and tactile changes at the skin surface, but physiological changes below the skin precede surface changes and have a significant impact on tissue health. Inflammatory and apoptotic/necrotic changes in the epidermal and dermal layers of the skin, such as changes in interstitial fluid (also known as subepidermal moisture (SEM)), may precede surface changes by 3-10 days. Those same epidermal and subepidermal changes result in changes in the electrical properties (bioimpedance) of the tissue, thereby presenting an objective, non-invasive method for assessing tissue damage. Clinical studies of bioimpedance for the detection of pressure ulcers have demonstrated that changes in bioimpedance correlate with increasing severity of pressure ulcer stages. Studies have also demonstrated that at anatomical locations with pressure ulcers, bioimpedance varies with distance from the centre of the pressure ulcers. The SEM Scanner, a handheld medical device, offers an objective and reliable method for the assessment of local bioimpedance, and therefore, assessment of tissue damage before signs become visible to the unaided eye. This literature review summarises pressure ulcer pathophysiology, principles of bioimpedance and clinical research using bioimpedance technology to assess pressure ulcers.

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Section: The Spatial Distribution Of Damage In Pressure Ulcersmentioning

confidence: 99%

Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure‐induced tissue damage (pressure ulcers)

Moore

Patton

Rhodes

et al. 2016

International Wound Journal

101

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“…Comparing the healthy region with the damaged area, it was found that no papillae or collagen fibrils were intact in the damaged area. This is the most likely cause of early stage pressure ulcer formation as the papillae may be destroyed without the dermis being destroyed, however papillae in aged skin tend to be flat with or without pressure, therefore it may be difficult to determine whether the absence of papillae in aged skin are due to aged skin or early pressure ulcer formation 14 . The paper did not mention however, whether it was possible that changes in papillae can be a sign of early stage 1 pressure ulcer development.…”

Section: Evidence For Early Pressure Wound Formationmentioning

confidence: 99%

A literature review of different pressure ulcer models from 1942–2005 and the development of an ideal animal model

Nguyen

Smith

Reynolds

2008

Australas. Phys. Eng. Sci. Med.

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The literature from 1942-2005 was reviewed in order to determine an inexpensive animal model which can closely mimic pressure ulcers seen in humans of varying ages, without the need for surgical procedures. Two animal models for producing pressure ulcers were found to be inexpensive: pigs to mimic pressure ulcers in young humans due to their fixed skin, and rats to mimic pressure ulcers in the elderly due to their loose skin. The methods which were found to be inexpensive, reproducible, non-invasive and easy to carry out without the need of a surgeon or specialist were the use of magnets for rat models and the use of a cast placed over a bony prominence for pig models.

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“…Biomarkers are indicators of internal physiological processes (e.g., lactate levels indicating an anaerobe metabolism) and can be used to assess the integrity of soft tissues . Concerning pressure ulcers, two main physiological processes, described in histological studies, are inflammation and edema (or interstitial fluid accumulation) . One study has demonstrated the potential of C‐reactive protein (CRP) levels in blood samples as a chemical biomarker of inflammation associated with muscle damage in deep tissue injury .…”

Section: Introductionmentioning

confidence: 99%

“…22 Concerning pressure ulcers, two main physiological processes, described in histological studies, are inflammation and edema (or interstitial fluid accumulation). [41][42][43][44][45][46][47][48] One study has demonstrated the potential of C-reactive protein (CRP) levels in blood samples as a chemical biomarker of inflammation associated with muscle damage in deep tissue injury. 49 In contrast, biomarkers sampled from the skin surface (e.g., sweat lactate) were not able to reflect damage to the subcutaneous tissue and muscle tissue.…”

Section: Introductionmentioning

confidence: 99%

Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review

Damme

Hecke

Remue

et al. 2019

Wound Repair Regeneration

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Deep tissue injuries are pressure ulcers which initiate in the subcutaneous tissues and extend through a bottom‐up pathway. Once deep tissue injuries are visual at skin level, serious irreversible tissue damage has already occurred. In pressure ulcer development, inflammation and edema are coupled physiological processes associated with tissue damage arising due to sustained mechanical loading. This study aimed to provide an in‐depth overview of the physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues, in the context of pressure ulceration. A scoping review was performed according to the framework by Arksey and O'Malley. The databases MEDLINE, EMBASE, Web of Science, and Scopus, and the reference lists of included studies were searched for in vivo (animal, human), and in vitro studies matching the study objectives (from inception to 28 May 2018). No restrictions for inclusion were applied for study design, setting, participants, and year of publication. A total of 12 studies were included, varying in study design, sample characteristics, amount and duration of mechanical loads that were applied, follow‐up time, and assessment methods. Neutrophil infiltration and edema occur in the subcutaneous tissues nearly immediately after the application of load on soft tissues. The amount of neutrophils and edema increase in the first days after the mechanical insult and decrease once healing has been initiated and no supplementary mechanical load was applied. One study indicated that edema may extend up to the level of the dermo‐epidermal junction. Further research should focus on how deep tissue inflammation and edema are reflected into unique tissue changes at skin level, and how abnormal inflammatory responses manifest (e.g. when the nervous system is not functioning normally).

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Morphological Characteristics of the Dermal Papillae in the Development of Pressure Sores

Cited by 25 publications

References 6 publications

Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure‐induced tissue damage (pressure ulcers)

Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure‐induced tissue damage (pressure ulcers)

A literature review of different pressure ulcer models from 1942–2005 and the development of an ideal animal model

Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review

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