Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure

Bergstrand, Sara

doi:10.3384/diss.diva-109960

Cited by 5 publications

(5 citation statements)

References 101 publications

(151 reference statements)

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“…This knowledge can potentially be translated to diabetic foot ulcer prediction to see if the microcirculatory response to local pressure and plantar pressure have any association. This also accords with other observations, which showed that people with impaired or absent PIV are known to be at a higher risk to develop pressure ulcers ( Fromy et al, 2002 ; Braden and Blanchard, 2007 ; Bergstrand, 2014 ). Evidence shows that decreased hyperaemic response and absence of PIV is known to increase the risk of pressure ulcers ( Bergstrand et al, 2014 ).…”

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationssupporting

confidence: 92%

“…Current studies highlight PIV in relation to the development of pressure ulcers or decubitus ulcers in the sacral region. As discussed above, one of the key implications from the studies on PIV is that it is a protective mechanism without which certain pressure-associated lesions may develop and plausibly this could explain the high risk of decubitus and plantar ulcers in people with diabetes ( Abraham et al, 2001 ; Fromy et al, 2002 ; Bergstrand, 2014 ). Although pressure ulcers and plantar ulcers may differ in many ways, one of the key causal pathways to foot ulceration is somatic motor neuropathy that leads to small muscle wasting, foot deformities, loss of sensation, increased plantar pressure and repetitive trauma resulting in neuropathic foot ulcer ( Armstrong and Lavery, 2005 ).…”

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationsmentioning

confidence: 99%

“…Understanding PIV, reduced skin flow and other microcirculatory responses in various regions prone to diabetic foot ulcers and in relation to plantar pressure during standing or walking are important. The need for such a study is further supported by the evidence from a study that identified subjects who lacked PIV and reactive hyperaemia in response to locally applied pressure, to be particularly vulnerable to pressure exposure ( Bergstrand, 2014 ; Bergstrand et al, 2014 ). These subjects were stratified to be at a higher risk for pressure ulcer development ( Bergstrand, 2014 ; Bergstrand et al, 2014 ).…”

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationsmentioning

confidence: 99%

“…The need for such a study is further supported by the evidence from a study that identified subjects who lacked PIV and reactive hyperaemia in response to locally applied pressure, to be particularly vulnerable to pressure exposure ( Bergstrand, 2014 ; Bergstrand et al, 2014 ). These subjects were stratified to be at a higher risk for pressure ulcer development ( Bergstrand, 2014 ; Bergstrand et al, 2014 ). Thereby, translating the knowledge generated from the studies on microcirculatory responses in the development of pressure ulcers to diabetic foot ulcers can prove to be useful.…”

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationsmentioning

confidence: 99%

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The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

Balasubramanian

Chockalingam

Naemi

2021

Front. Bioeng. Biotechnol.

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Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.

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Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationssupporting

confidence: 92%

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationsmentioning

confidence: 99%

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationsmentioning

confidence: 99%

Section: Various Microcirculatory Responses and Their Association In Diabetes Foot-related Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

Balasubramanian

Chockalingam

Naemi

2021

Front. Bioeng. Biotechnol.

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“…The analysis suggests that participant type explains rather more variance than BMI category in the PPI outcome measure. This is supported by Bergstrand 43 who also found that age impacted PPI rather than BMI. Further work is required to determine if these initial effects are borne out in studies with larger samples in the intensive care environment.…”

Section: Discussionmentioning

confidence: 53%

Exploring pressures, tissue reperfusion and body positioning: a pilot evaluation

et al. 2017

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Objective To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature; and interface pressure (IP) and tissue reperfusion (TR). Also to assess the relationship in critically ill patients between: sequential organ failure assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, and IP and TR. Setting 27-bed intensive care unit (ICU) of an Australia tertiary hospital. Participants 23 low-and high-acuity ICU patients and 9 healthy adult volunteers. Methods IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), and peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. Results Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings substantively differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling additionally for age and BMI. The controlling variable of age was also significant (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were revealed; however, temperature was revealed to be substantively related to TR (p=0.091). Conclusions While not being powered to detect significant effects, this pilot analysis has nonetheless determined several associations of importance, with substantive differences in outcomes observed between low-and high-acuity ICU patients; and between ICU patients and healthy volunteers.

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Novel Deproteinised Natural Rubber Latex Slow-recovery Foam for Health Care and Therapeutic Foam Product Applications

et al. 2018

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Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure

Cited by 5 publications

References 101 publications

The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

Exploring pressures, tissue reperfusion and body positioning: a pilot evaluation

Novel Deproteinised Natural Rubber Latex Slow-recovery Foam for Health Care and Therapeutic Foam Product Applications

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