Article

Compression-induced damage and internal tissue strains are related

Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Building W-hoog 4.11, 5600 MB Eindhoven, The Netherlands.
Journal of Biomechanics (Impact Factor: 2.5). 12/2008; 41(16):3399-404. DOI: 10.1016/j.jbiomech.2008.09.016
Source: PubMed

ABSTRACT Prolonged mechanical loading of soft tissues adjacent to bony prominences can lead to degeneration of muscle tissue, resulting in a condition termed pressure-related deep tissue injury. This type of deep pressure ulcers can develop into a severe wound, associated with problematic healing and a variable prognosis. Limited knowledge of the underlying damage pathways impedes effective preventive strategies and early detection. Traditionally, pressure-induced ischaemia has been thought to be the main aetiological factor for initiating damage. Recent research, however, proposes tissue deformation per se as another candidate for initiating pressure-induced deep tissue injury. In this study, different strain parameters were evaluated on their suitability as a generic predictive indicator for deep tissue injury. With a combined animal-experimental numerical approach, we show that there is a reproducible monotonic increase in damage with increasing maximum shear strain once a strain threshold has been exceeded. This relationship between maximum shear strain and damage seems to reflect an intrinsic muscle property, as it applied across a considerable number of the experiments. This finding confirms that tissue deformation per se is important in the aetiology of deep tissue injury. Using dedicated finite element modeling, a considerable reduction in the inherent biological variation was obtained, leading to the proposal that muscle deformation can prove a generic predictive indicator of damage.

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Available from: Gustav J Strijkers, Aug 16, 2015
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    • "Furthermore, animal experiments involving 2 hours of muscle compression showed that while a complete area of muscle was ischaemic, damage occurred in specific regions where high shear strain values were observed (Stekelenburg et al. 2007). Subsequent work using finite element simulations revealed that the areas of tissue damage coincided with those where the predicted strains exceeded a critical threshold (Ceelen et al. 2008). Once the critical threshold has been exceeded, the length of the exposure determined the extent of tissue damage, (Loerakker et al. 2010). "
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    ABSTRACT: AimTo agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BackgroundA recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DesignConsensus study.MethodA modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010–December 2011.FindingsThe risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.Conclusion The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework.
    Journal of Advanced Nursing 05/2014; 70(10). DOI:10.1111/jan.12444 · 1.69 Impact Factor
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    • "Furthermore, animal experiments involving 2 hours of muscle compression showed that while a complete area of muscle was ischaemic, damage occurred in specific regions where high shear strain values were observed (Stekelenburg et al. 2007). Subsequent work using finite element simulations revealed that the areas of tissue damage coincided with those where the predicted strains exceeded a critical threshold (Ceelen et al. 2008). Once the critical threshold has been exceeded, the length of the exposure determined the extent of tissue damage, (Loerakker et al. 2010). "
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    Journal of Advanced Nursing 03/2014; 70(10). DOI:10.1111/jan.12405 · 1.69 Impact Factor
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    • "In the last 15 years a variety of model systems have been used to study the aetiology of DTI, ranging from in vitro studies on single cells (Bouten et al., 2001; Wang et al., 2005), to tissue engineered muscle constructs (Breuls et al., 2003; Gawlitta et al., 2007; Gefen et al., 2008) and animal studies (Bosboom et al., 2001; Ceelen et al., 2008; Loerakker et al., 2011; Stekelenburg et al., 2008). All these studies, focused on skeletal muscle cells and tissues, confirmed that two damage mechanisms play a major role in prolonged mechanical-induced damage. "
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