The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers

Area of Science:

• Biomedical Engineering
• Wound Care
• Tissue Mechanics

Background:

• International guidelines and expert reports from 2019-2022 highlight pressure ulcers/injuries (PU/Is).
• Focus on device-related PU/Is and those from bodyweight pressure.
• Understanding PU/I etiology is crucial for effective prevention strategies.

Purpose of the Study:

• To comprehensively summarize the causes of pressure ulcers/injuries (PU/Is).
• To synthesize current knowledge from leading clinical practice guidelines and expert consensus documents.
• To elucidate the pathophysiology of PU/Is for improved prevention.

Main Methods:

• Literature review focusing on prolonged soft tissue deformations.
• Analysis of cell and tissue viability under mechanical loading.
• Synthesis of data from the 2019 International Clinical Practice Guideline and SECURE Prevention reports (2020, 2022).

Main Results:

• Prolonged soft tissue deformation leads to microscopic cell death and tissue damage.
• Clinical manifestation of PU/Is can take hours after initial mechanical insult.
• Superficial PU/Is are linked to shear loading; deep tissue injuries result from stress concentrations at bony prominences or under medical devices.

Conclusions:

• Primary prevention of PU/Is requires alleviating stress concentrations on cells and tissues.
• Strategies include reducing the intensity of mechanical stress.
• Decreasing the duration of tissue exposure to stress is also a key preventive measure.