Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage

Abstract

Pressure ulcers (PrUs) affect approximately 2.5 million patients and account for 60,000 deaths annually. They are associated with an additional annual cost of $43,000 per related hospital stay and a total cost to the US health care system as high as $25 billion. Despite the implementation of national and international PrU prevention guidelines and toolkits, rates of facility-acquired PrU s and PrUs in people with spinal cord injury are still high. A new paradigm is needed that distinguishes between prevention and treatment research methods and includes not only the causative factors of pressure and tissue deformation but also patient-specific anatomical differences and the concomitant biological cellular processes, including reperfusion injury, toxic metabolites, ischemia, cell distortion, impaired lymphatic drainage, and impaired interstitial fluid flow that compound existing tissue damage.

Evaluation of postural systems of the pelvis in a person with Limb-Girdle Muscular Dystrophy: results of the analysis of three cushions in the promotion of dynamic balance

“…O cisalhamento e a fricção têm sido relatados como os responsáveis pelos danos nas camadas epidérmicas e cutâneas e capilares, enquanto a carga mecânica induz alterações no fluxo e pressão intersticial do fluido que levam a perturbações no equilíbrio metabólico resultando em necrose dos tecidos. Todos os tecidos, e as células dentro desses tecidos, são esticados e distorcidos pelo peso, proeminências, ou dispositivos (Gould et al, 2019).…”

“…A opinião predominante é que a minimização da pressão, cisalhamento e duração da carga reduzirá o risco de úlcera de pressão. No entanto, é importante destacar a multifatoriedade do aparecimento das úlceras e que a sua prevenção e o tratamento devem ter em conta as variações individuais na tolerância à deformação celular e tecidual, como a idade, estado neuromuscular e os demais aspetos fisiológicos, e que o risco biomecânico individualizado deve incluir tecidos profundos à pele (Gould et al, 2019).…”

“…At the same time, mechanical loading induces changes in interstitial fluid flow and pressure that lead to disturbances in metabolic balance, resulting in tissue necrosis. All tissues, and the cells within those tissues, are stretched and distorted by weight, prominences, or devices (Gould et al, 2019).…”

“…The prevailing opinion is that minimising pressure, shear and load duration will reduce the risk of pressure ulcers. However, it is important to highlight the multifactoriality of ulcer occurrence and that ulcer prevention and treatment should take into account individual variations in tolerance to cell and tissue deformation, such as age, neuromuscular status and other physiological aspects, and that individualised biomechanical risk should include tissues deep to the skin (Gould et al, 2019).…”

Exploring the role of transtibial prosthetic use in deep tissue injury development: a scoping review

“…This high number reflects the shortfalls in the prevention, diagnosis, and treatment of pressure injuries, which may be ascribed to ambiguities about their aetiology [ 3 ]. An example for ongoing controversies is the recent addition of Deep Tissue Injuries (DTI) to the established pressure ulcer staging system of the National Pressure Ulcer Advisory Panel (NPUAP) [ 1 ].…”