There is an individual tolerance to mechanical loading in compression induced deep tissue injury

Traa, Willeke A.; Turnhout, Mark C. van; Nelissen, Jules L.; Strijkers, Gustav J.; Bader, Dan L.; Oomens, C.W.J.

doi:10.1016/j.clinbiomech.2019.02.015

Cited by 12 publications

(12 citation statements)

References 32 publications

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“…This is corroborated by finite element analyses, which give typical mean strain estimates of 3-15% for both principal tension, compression, and maximal shear, and strain peaks of 30-75% [15,17,38]. The estimated strain distribution lies below estimated thresholds for skeletal muscle damage from engineered tissue and rat models [39,40]. Strain predictions were consistent with the design intent for TSB [4] and PTB [5,6] socket types, and provided a noteworthy illustration of how sub-surface shear strain gradients-a marker of deep tissue injury risk-may be generated near bony prominences in the absence of interface pressure near the anterior distal tip of the tibia.…”

Section: Discussionsupporting

confidence: 52%

Developing an Analogue Residual Limb for Comparative DVC Analysis of Transtibial Prosthetic Socket Designs

et al. 2020

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Personalised prosthetic sockets are fabricated by expert clinicians in a skill- and experience-based process, with research providing tools to support evidence-based practice. We propose that digital volume correlation (DVC) may offer a deeper understanding of load transfer from prosthetic sockets into the residual limb, and tissue injury risk. This study’s aim was to develop a transtibial amputated limb analogue for volumetric strain estimation using DVC, evaluating its ability to distinguish between socket designs. A soft tissue analogue material was developed, comprising silicone elastomer and sand particles as fiducial markers for image correlation. The material was cast to form an analogue residual limb informed by an MRI scan of a person with transtibial amputation, for whom two polymer check sockets were produced by an expert prosthetist. The model was micro-CT scanned according to (i) an unloaded noise study protocol and (ii) a case study comparison between the two socket designs, loaded to represent two-legged stance. The scans were reconstructed to give 108 µm voxels. The DVC noise study indicated a 64 vx subvolume and 50% overlap, giving better than 0.32% strain sensitivity, and ~3.5 mm spatial resolution of strain. Strain fields induced by the loaded sockets indicated tensile, compressive and shear strain magnitudes in the order of 10%, with a high signal:noise ratio enabling distinction between the two socket designs. DVC may not be applicable for socket design in the clinical setting, but does offer critical 3D strain information from which existing in vitro and in silico tools can be compared and validated to support the design and manufacture of prosthetic sockets, and enhance the biomechanical understanding of the load transfer between the limb and the prosthesis.

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Section: Discussionsupporting

confidence: 52%

Developing an Analogue Residual Limb for Comparative DVC Analysis of Transtibial Prosthetic Socket Designs

et al. 2020

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“…At a certain stage, the growing interstitial pressures may reach a level that would cause obstruction of the vasculature itself which will impair blood perfusion into the affected tissue site and thereby trigger ischaemic damage. These synergistic interactions between sustained cell and tissue deformations, inflammation and ischaemia form the vicious cycle of the development and progression of PIs as we currently understand it (Figure 2) and are always specific to the individual patient, depending on their respective body system functions 9 .…”

Section: Resultsmentioning

confidence: 99%

What is new in our understanding of pressure injuries: the inextricable association between sustained tissue deformations and pain and the role of the support surface

Gefen¹,

Soppi²

2020

WPR

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“…13 However, a target value for shear force has not yet been determined. Furthermore, individual differences in tissue tolerance to mechanical loading exist, 14 possibly explaining why some patients still develop PIs despite the use of preventive interventions to measure external forces and redistribute pressure. Biochemical measurement of biomarkers, such as skin blotting 15 and Sebutape, 16 has been proposed to assess tissue status or viability due to mechanical loading.…”

Section: Introductionmentioning

confidence: 99%

Identification of microRNAs responsive to shear loading in rat skin

Hsu

Minematsu

Nakagami

et al. 2021

International Wound Journal

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Pressure injuries (PIs) are localised skin injuries that result from pressure with or without shear force. Shear force is more destructive than pressure in clinical settings. Therefore, determining the critical external forces is important for selecting the appropriate care to prevent PIs. To quantitatively distinguish pressure and shear loading with high specificity, we focused on microRNAs (miRs). This study aimed to identify the miRs that are distinguishable between pressure with and without shear loading in rat skin. Microarray analysis identified six candidate miRs from the comparisons among the pressure, shear, and unloaded groups. We analysed the expression levels of the candidate miRs in the process of PI development using real-time reverse transcriptase polymerase chain reaction. In the pressure and shear groups, miR-92b expressions at 6 hours after loading were 2.3 ± 1.3 and 2.9 ± 1.0, respectively, which were significantly higher than those in the control group (P = .014 and .004, respectively). miR-877 expression at 6 hours after loading was significantly increased only in the shear group (2.8 ± 0.9) compared with the control group (P = .016). These results indicate that miR-92b and miR-877 are promising biomarkers to determine for which external force healthcare professionals should intervene. K E Y W O R D SmicroRNAs, pressure ulcer Key messages • this study aimed to identify the miRs that are distinguishable between pressure with and without shear loading in rat skin. • microarray profile was used to select candidate miRs responsive to pressure with and without shear loading. • the expression levels of miR-92b in the pressure and shear group were significantly higher than that in the control group at 6 and 24 hours after

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There is an individual tolerance to mechanical loading in compression induced deep tissue injury

Cited by 12 publications

References 32 publications

Developing an Analogue Residual Limb for Comparative DVC Analysis of Transtibial Prosthetic Socket Designs

Developing an Analogue Residual Limb for Comparative DVC Analysis of Transtibial Prosthetic Socket Designs

What is new in our understanding of pressure injuries: the inextricable association between sustained tissue deformations and pain and the role of the support surface

Identification of microRNAs responsive to shear loading in rat skin

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