Ultrasound Assessment of Deep Tissue Injury in Pressure Ulcers: Possible Prediction of Pressure Ulcer Progression

Aoi, Noriyuki; Yoshimura, Kotaro; Kadono, Takafumi; Nakagami, Gojiro; Iizuka, Shinji; Higashino, Takuya; Araki, Jun; Koshima, Isao; Sanada, Hiromi

doi:10.1097/prs.0b013e3181addb33

Cited by 104 publications

(91 citation statements)

References 20 publications

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“…37 It is known that adipose tissue is more vulnerable to ischemia than skin, and necrosis of subcutaneous adipose tissue, known as deep tissue injury, can seriously affect the vascularity of overlying skin. 41 Therefore, it is practical to target adipose tissue for angiogenesis in clinical settings. For example, AIC could be used to treat intractable skin ulcers with ischemia or hypoxia, such as diabetic or decubitus ulcers, or to improve vascularity in ischemic limbs with artery occlusive diseases.…”

Section: Discussionmentioning

confidence: 99%

Adipose Injury–Associated Factors Mitigate Hypoxia in Ischemic Tissues through Activation of Adipose-Derived Stem/Progenitor/Stromal Cells and Induction of Angiogenesis

Eto

Suga

Inoue

et al. 2011

The American Journal of Pathology

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Based on the analysis of exudates from injured adipose tissue, we prepared a mixture containing the injury-associated growth factors at the same proportion as the exudates, named adipose injury cocktail (AIC). We hypothesized that AIC induces a series of regenerating and angiogenic processes without actual wounding. The purpose of this study is to elucidate the therapeutic potentials of AIC. AIC preferentially activated adipose-derived stem/progenitor/stromal cells (ASCs) to proliferate, migrate, and form networks compared with vascular endothelial cells, whereas vascular endothelial growth factor did not induce mitogenesis or chemotaxis in human ASCs. Each component growth factor of AIC was differently responsible for the ASC activation. AIC-treated ASCs tended to differentiate into adipocytes or vessel-constituting cells rather than into other cell types. In ischemic adipose tissues of mice, induced by either a surgical intervention or diabetes, AIC administration enhanced proliferation, especially of CD31 -/CD34 ؉ ASCs, and mitigated tissue hypoxia by increasing capillary density and reducing fibrogenesis. These results suggest that AIC may have therapeutic potentials for various ischemic/hypoxic conditions by inducing adipose remodeling and neovascularization through activation of ASCs and other cells. Treatment with AIC has many advantages over cell-based therapies regarding morbidity, cost, and physical risks and may be used as an alternative therapy for improving tissue oxygen.

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Section: Discussionmentioning

confidence: 99%

Adipose Injury–Associated Factors Mitigate Hypoxia in Ischemic Tissues through Activation of Adipose-Derived Stem/Progenitor/Stromal Cells and Induction of Angiogenesis

Eto

Suga

Inoue

et al. 2011

The American Journal of Pathology

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“…A deep tissue injury (DTI) is a localized area of discoloration, usually maroon or purple, that represents deep tissue injury under intact skin (Alderden, Whitney, Taylor, & Zaratkiewicz, 2011). The area of tissue may be painful, firm, mushy, boggy, warmer or cooler as compared with adjacent tissue (Aoi et al, 2009). Stage I pressure ulcers are characterized by intact skin with nonblanching erythema of a localized area.…”

Section: Definition Risk Factors and Stagingmentioning

confidence: 99%

“…There are several pressure ulcer risk assessment scales being used, such as the Norton scale, the RAPS, and the Braden Scale (Aoi et al, 2009). These pressure ulcer classifications scales use a numerical rating score in which certain criteria are given an assigned score to differentiate between different levels of risk (Whiteing, 2009).…”

Section: Skin Assessmentmentioning

confidence: 99%

Pressure Ulcer Assessment and Documentation

Ruggiero

2015

Preprint

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Assessment and Documentation Pocket Guide to assess patients during the monthly meeting and then completed an evaluation. The guide was evaluated as being valuable in assessing and documenting pressure ulcers and it was recommended for distribution to staff nurses. Use of the tool has the potential to improve assessment, identification, and documentation of pressure ulcers. Implications for advanced practice are discussed. Acknowledgements

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“…A previous cohort study reported that the use of high-frequency US can help visualize the deep tissue to assess the degree of damage. 15 Aoi et al reported the US characteristics that could predict deterioration. 15 Thermography has been tested to detect latent inflammation in PUs, including those with critical colonization.…”

Section: Introductionmentioning

confidence: 99%

“…15 Aoi et al reported the US characteristics that could predict deterioration. 15 Thermography has been tested to detect latent inflammation in PUs, including those with critical colonization. 16 Nakagami et al reported that PUs were classified into two groups depending on whether the wound site temperature was lower or higher than the peri-wound skin temperature; a higher wound site temperature may imply the presence of critical colonization.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses: a non-randomized controlled trial

Kaitani¹,

Nakagami²,

Sugama³

et al. 2015

CWCMR

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Aims and objectives:We investigated the effectiveness and safety of an advanced pressure ulcer (PU) management protocol comprising 1) ultrasonography to assess the deep tissue, 2) use of a non-contact thermometer to detect critical colonization, 3) conservative sharp debridement, 4) dressing selection, 5) negative pressure wound therapy, and 6) vibration therapy in comparison with those of a conventional approach. Each protocol was followed by trained wound, ostomy, and continence nurses (WOCNs). Background: At present, there is no systematic PU management protocol for nurses that includes appropriate assessment and intervention techniques for deep tissue injury and critical colonization. In Japan, there is no such protocol that the nurses can follow without a physician's orders. Design and methods: This was a prospective non-randomized controlled trial. Over a 3-week period, we evaluated the effectiveness of an advanced protocol by comparing the PU severity and healing on the basis of the DESIGN-R scale and presence of patients' discomfort. We recruited ten WOCNs to follow the advanced protocol and 19 others as controls. Statistical analysis included a linear mixed-effects model and a logistic regression model. Results: In week 0-1, the advanced protocol was significantly associated with prevention of PU deterioration. Using the linear mixed-effects model, we observed a greater decrease in the DESIGN-R score (healing) in the advanced protocol group. There were no reports of excessive bleeding, pain or infection with the advanced protocol. Conclusion: Using the advanced protocol, WOCNs detected PU severity, assessed PUs, and treated PUs safely. This protocol prevented PU deterioration and/or facilitated wound healing. Relevance to clinical practice: With proper training, WOCNs can assess and treat PUs safer and quicker than when a physician's assessment is required, leading to an improvement in wound healing and prevention of PU deterioration.

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Ultrasound Assessment of Deep Tissue Injury in Pressure Ulcers: Possible Prediction of Pressure Ulcer Progression

Abstract: The use of intermediate-frequency ultrasound reliably identified deep tissue injury and was believed to contribute to prevention and treatment of pressure-related ulcers. The results suggest that specific ultrasonographic characteristics may predict which pressure ulcers will progress.

Cited by 104 publications

References 20 publications

Adipose Injury–Associated Factors Mitigate Hypoxia in Ischemic Tissues through Activation of Adipose-Derived Stem/Progenitor/Stromal Cells and Induction of Angiogenesis

Adipose Injury–Associated Factors Mitigate Hypoxia in Ischemic Tissues through Activation of Adipose-Derived Stem/Progenitor/Stromal Cells and Induction of Angiogenesis

Pressure Ulcer Assessment and Documentation

Evaluation of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses: a non-randomized controlled trial

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