scholarly journals Deep tissue injury: a narrative review on the aetiology of a controversial wound

2021 ◽  
Vol 30 (5) ◽  
pp. S32-S37
Author(s):  
Matthew Wynn
Keyword(s):  
Pressure Ulcer ◽  
Tissue Injury ◽  
Human Subjects ◽  
Healthcare Services ◽  
Narrative Review ◽  
Advisory Panel ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Pressure Injury ◽  
Governance Processes

Deep tissue injuries (DTIs) were added to pressure ulcer grading systems in 2009. Since then, they have been associated with the same aetiological processes as other forms of pressure injury (PI). This is despite notable clinical differences in their presentation along with variations in natural history that suggest they are the consequence of processes distinct from those that cause other PIs. Understanding the aetiology of DTIs is essential to guide prevention and treatment in addition to ensuring healthcare governance processes deeply tied to pressure injury are effective and efficient. Current understanding of the aetiology of DTI has significant gaps, with several key challenges impeding progress in this area of PI research, including inconsistent reporting by healthcare services and the limitations of animal and computer models in addition to the ethical barriers to conducting studies on human subjects. Synthesis of early studies with studies undertaken before 2009 is also limited by the variety in definitions of DTI used before that published by the European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance in 2009. To date, few prospective clinical studies have been conducted. This article presents a narrative review on the clinical and animal study evidence indicating contemporary understanding of DTI.

scholarly journals Muscle apoptosis is induced in pressure-induced deep tissue injury

2009 ◽  
Vol 107 (4) ◽  
pp. 1266-1275 ◽  
Author(s):  
Parco M. Siu ◽  
Eric W. Tam ◽  
Bee T. Teng ◽  
Xiao M. Pei ◽  
Joann W. Ng ◽  
...  
Keyword(s):  
Cell Death ◽  
Muscle Tissue ◽  
Pressure Ulcer ◽  
Molecular Mechanisms ◽  
Caspase 3 ◽  
Tissue Injury ◽  
Immunocytochemical Staining ◽  
Sprague Dawley ◽  
Deep Tissue ◽  
Deep Tissue Injury

Pressure ulcer is a complex and significant health problem. Although the factors including pressure, shear, and ischemia have been identified in the etiology of pressure ulcer, the cellular and molecular mechanisms that contribute to the development of pressure ulcer are unclear. This study tested the hypothesis that the early-onset molecular regulation of pressure ulcer involves apoptosis in muscle tissue. Adult Sprague-Dawley rats were subjected to an in vivo protocol to mimic pressure-induced deep tissue injury. Static pressure was applied to the tibialis region of the right limb of the rats for 6 h each day on two consecutive days. The compression force was continuously monitored by a three-axial force transducer equipped in the compression indentor. The contralateral uncompressed limb served as intra-animal control. Tissues underneath the compressed region were collected for histological analysis, terminal dUTP nick-end labeling (TUNEL), cell death ELISA, immunocytochemical staining, and real-time RT-PCR gene expression analysis. The compressed muscle tissue generally demonstrated degenerative characteristics. TUNEL/dystrophin labeling showed a significant increase in the apoptotic muscle-related nuclei, and cell death ELISA demonstrated a threefold elevation of apoptotic DNA fragmentation in the compressed muscle tissue relative to control. Positive immunoreactivities of cleaved caspase-3, Bax, and Bcl-2 were evident in compressed muscle. The mRNA contents of Bax, caspase-3, caspase-8, and caspase-9 were found to be higher in the compressed muscle tissue than control. These results demonstrated that apoptosis is activated in muscle tissue following prolonged moderate compression. The data are consistent with the hypothesis that muscle apoptosis is involved in the underlying mechanism of pressure-induced deep tissue injury.

scholarly journals Deep tissue injury rat model for pressure ulcer research on spinal cord injury

2010 ◽  
Vol 19 (2) ◽  
pp. 67-76 ◽  
Author(s):  
Fang Lin ◽  
Atek Pandya ◽  
Andrew Cichowski ◽  
Mauli Modi ◽  
Briana Reprogle ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Rat Model ◽  
Tissue Injury ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Cord Injury

Pressure-Related Deep Tissue Injury under Intact Skin and the Current Pressure Ulcer Staging Systems

2005 ◽  
Vol 18 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Michael A. Ankrom ◽  
Richard G. Bennett ◽  
Stephen Sprigle ◽  
Diane Langemo ◽  
Joyce M. Black ◽  
...  
Keyword(s):  
Pressure Ulcer ◽  
Tissue Injury ◽  
Intact Skin ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Staging Systems

Update on Pressure Ulcer Management and Deep Tissue Injury

2010 ◽  
Vol 44 (2) ◽  
pp. 325-332 ◽  
Author(s):  
Cindy L Mao ◽  
Amanda J Rivet ◽  
Tara Sidora ◽  
Mary T Pasko
Keyword(s):  
Pressure Ulcer ◽  
Tissue Injury ◽  
Deep Tissue ◽  
Deep Tissue Injury

scholarly journals An animal model for simulating deep tissue injury for pressure ulcer research on spinal cord injury

2010 ◽  
Vol 24 (S1) ◽  
Author(s):  
Mohsen Makhsous ◽  
Fang Lin ◽  
Andrew Cichowski ◽  
Atek Pandya ◽  
Mauli Modi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Animal Model ◽  
Pressure Ulcer ◽  
Tissue Injury ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Cord Injury

The Relative Contributions of Muscle Deformation and Ischemia to Pressure Ulcer Development

2012 ◽  
Author(s):  
Sandra Loerakker ◽  
Gustav J. Strijkers ◽  
Klaas Nicolay ◽  
Frank P. T. Baaijens ◽  
Dan L. Bader ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Muscle Tissue ◽  
Pressure Ulcer ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Skeletal Muscle Tissue ◽  
Ischemia And Reperfusion ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Damage Process

Sustained mechanical loading of soft tissues covering bony prominences may lead to degeneration of skeletal muscle tissue. This can result in a condition termed deep tissue injury (DTI), a severe kind of pressure ulcer that initiates in deep tissue layers, and progresses towards the skin. Previously, we have provided evidence that in a controlled animal model, deformation is the main trigger for damage within a 2 h loading period [1,2]. Recently, we also showed that ischemia and reperfusion may contribute to the damage process during prolonged loading [3]. In the present study, we investigated the relative effects of deformation, ischemia, and reperfusion on the temporal and spatial damage process of skeletal muscle tissue during a 6 h period using magnetic resonance imaging (MRI) techniques.

Sign in / Sign up

Export Citation Format

Share Document