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: 2.75). 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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    • "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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    • "Other studies involving static loading using animal modeling and finite-element modeling have suggested that shear deformation of tissue initiates short-term tissue damage. After the initiation of damage, ischemia may accelerate injury due to hypoxia, glucose depletion, and acidification11, 12). On the other hand, Lahmann and Kottner13) reported that there is a strong relationship between friction forces and superficial skin lesions and between pressure forces and deep tissue injury. "
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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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