Pressure ulcers and deep tissue injury: a bioengineering perspective.

Wheelchair users are highly susceptible to deep tissue injury. Interface pressures are unlikely to predict this, and an alternative assessment approach is needed that can easily monitor internal mechanical stresses and deformations.

[1]  Anderson Tp,et al.  Psychosocial factors associated with pressure sores. , 1979 .

[2]  T. Defloor,et al.  The risk of pressure sores: a conceptual scheme. , 1999, Journal of clinical nursing.

[3]  Garber Sl,et al.  Wheelchair cushion modification and its effect on pressure. , 1984 .

[4]  J. Bleiberg,et al.  Wheelchair push-ups: measuring pressure relief frequency. , 1985, Archives of physical medicine and rehabilitation.

[5]  W. Mann,et al.  Evaluation of pressure and durability of a low-cost wheelchair cushion designed for developing countries. , 2003 .

[6]  Robert Ragan,et al.  Seat-interface pressures on various thicknesses of foam wheelchair cushions: a finite modeling approach. , 2002, Archives of physical medicine and rehabilitation.

[7]  Dan L Bader,et al.  A theoretical analysis of damage evolution in skeletal muscle tissue with reference to pressure ulcer development. , 2003, Journal of biomechanical engineering.

[8]  Pressure relief training device: the microcalculator. , 1981 .

[9]  J. Reuler,et al.  The pressure sore: pathophysiology and principles of management. , 1981, Annals of internal medicine.

[10]  J. Gaspoz,et al.  Hospital-acquired pressure ulcers: risk factors and use of preventive devices. , 1998, Archives of internal medicine.

[11]  T. Farley,et al.  An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors. , 2001, Archives of physical medicine and rehabilitation.

[12]  C. Lyder,et al.  Pressure ulcer prevention and management. , 2003, JAMA.

[13]  P Karg,et al.  A randomized control trial to evaluate pressure-reducing seat cushions for elderly wheelchair users. , 2001, Advances in skin & wound care.

[14]  Qunli Sun,et al.  Finite element modeling of human buttock-thigh tissue in a seated posture , 2005 .

[15]  M. Boninger,et al.  Displacement between the seating surface and hybrid test dummy during transitions with a variable configuration wheelchair: a technical note. , 2000, Journal of rehabilitation research and development.

[16]  E. Malheiro,et al.  Surgical treatment of pressure sores , 1999, European Journal of Plastic Surgery.

[17]  T. Defloor,et al.  Do Pressure Relief Cushions Really Relieve Pressure? , 2000, Western journal of nursing research.

[18]  W. E. Staas,et al.  Pressure sores--a multifaceted approach to prevention and treatment. , 1991, The Western journal of medicine.

[19]  C Hershler,et al.  Pressure ulcer prophylaxis in elderly patients using polyurethane foam or Jay wheelchair cushions. , 1994, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[20]  Ingrid Eitzen,et al.  Pressure mapping in seating: a frequency analysis approach. , 2004, Archives of physical medicine and rehabilitation.

[21]  A Gefen,et al.  In vivo muscle stiffening under bone compression promotes deep pressure sores. , 2005, Journal of biomechanical engineering.

[22]  A. Gefen,et al.  Stiffening of muscle tissue under bone compression is a key factor in formation of pressure sores , 2003, Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439).

[23]  M. Tsokos,et al.  Pressure sores: epidemiology, medico-legal implications and forensic argumentation concerning causality , 2000, International Journal of Legal Medicine.

[24]  S. Mason,et al.  Prognostic factors associated with pressure sore development in the immediate post-operative period. , 2000, International journal of nursing studies.

[25]  L M Vistnes,et al.  Differential Response of Skin and Muscle in the Experimental Production of Pressure Sores , 1980, Plastic and reconstructive surgery.

[26]  D. Ash An exploration of the occurrence of pressure ulcers in a British spinal injuries unit. , 2002, Journal of clinical nursing.

[27]  S. Pang,et al.  Predicting pressure sore risk with the Norton, Braden, and Waterlow scales in a Hong Kong rehabilitation hospital. , 1998, Nursing research.

[28]  Á. Thoroddsen,et al.  Pressure sore prevalence: a national survey. , 1999, Journal of clinical nursing.

[29]  M Arcan,et al.  Modeling the body/chair interaction - an integrative experimental-numerical approach. , 2000, Clinical biomechanics.

[30]  Cees W J Oomens,et al.  Predicting local cell deformations in engineered tissue constructs: a multilevel finite element approach. , 2002, Journal of biomechanical engineering.

[31]  F. Sorvillo,et al.  Pressure Ulcers: More Lethal Than We Thought? , 2005, Advances in skin & wound care.

[32]  C. Oomens,et al.  The etiology of pressure ulcers: skin deep or muscle bound? , 2003, Archives of physical medicine and rehabilitation.

[33]  E. Mathus-Vliegen Old age, malnutrition, and pressure sores: an ill-fated alliance. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[34]  B H GRIFFITH,et al.  Advances in the treatment of decubitus ulcers. , 1963, The Surgical clinics of North America.

[35]  D L Bader,et al.  Compression-induced deep tissue injury examined with magnetic resonance imaging and histology. , 2006, Journal of applied physiology.

[36]  David J Margolis,et al.  Medical conditions as risk factors for pressure ulcers in an outpatient setting. , 2003, Age and ageing.

[37]  J. Krause Skin sores after spinal cord injury: relationship to life adjustment , 1998, Spinal Cord.

[38]  John H Evans,et al.  Pelvic movement and interface pressure distribution during manual wheelchair propulsion. , 2003, Archives of physical medicine and rehabilitation.

[39]  K L Kennedy,et al.  The prevalence of pressure ulcers in an intermediate care facility. , 1989, Decubitus.

[40]  N P Reddy,et al.  Mechanisms of decubitus ulcer formation--an hypothesis. , 1978, Medical hypotheses.

[41]  Cees W J Oomens,et al.  In vitro models to study compressive strain-induced muscle cell damage. , 2003, Biorheology.

[42]  The limits of pressure sore prevention , 1999, Journal of the Royal Society of Medicine.

[43]  H. Maas,et al.  Noninvasive measurement of elastic properties of living tissue , 1999, 1999 European Control Conference (ECC).

[44]  R. Price,et al.  Gel wheelchair cushions: a potential cold weather hazard. , 1991, Archives of physical medicine and rehabilitation.

[45]  Cwj Cees Oomens,et al.  Compression Induced Cell Damage in Engineered Muscle Tissue: An In Vitro Model to Study Pressure Ulcer Aetiology , 2003, Annals of Biomedical Engineering.

[46]  Paul Miller,et al.  Computer Simulations of Two-Component Wheelchair Cushions , 2003 .

[47]  J. Donnelly,et al.  Should we include deep tissue injury in pressure ulcer staging systems? The NPUAP debate. , 2005, Journal of wound care.

[48]  J J Anderson,et al.  Are We Improving the Quality of Nursing Home Care: The Case of Pressure Ulcers , 2000, Journal of the American Geriatrics Society.

[49]  G A Ksander,et al.  An In‐Depth Look at Pressure Sores Using Monolithic Silicon Pressure Sensors , 1984, Plastic and reconstructive surgery.

[50]  J van Hoof,et al.  A Finite Element Model of the Human Buttocks for Prediction of Seat Pressure Distributions , 2004, Computer methods in biomechanics and biomedical engineering.

[51]  A. Gefen,et al.  Pressure-time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics. , 2006, Journal of biomechanics.

[52]  C. Oomens,et al.  Can Loaded Interface Characteristics Influence Strain Distributions in Muscle Adjacent to Bony Prominences? , 2003, Computer methods in biomechanics and biomedical engineering.

[53]  A. Tokuhiro,et al.  Evaluation of wheelchair cushions by means of pressure distribution mapping. , 1998, Acta Medica Okayama.

[54]  B. Bates-Jensen Quality Indicators for Prevention and Management of Pressure Ulcers in Vulnerable Elders , 2001, Annals of Internal Medicine.

[55]  J. Haalboom,et al.  Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E. , 2000, Journal of wound care.

[56]  Martin Ferguson-Pell,et al.  Remote monitoring of sitting behavior of people with spinal cord injury. , 2002, Journal of rehabilitation research and development.

[57]  Dianne Parker,et al.  Pressure relief behaviour and the prevention of pressure ulcers in wheelchair users in the community. , 2002, Journal of tissue viability.

[58]  R. Davis,et al.  Pressure sores: an operant conditioning approach to prevention. , 1975, Archives of physical medicine and rehabilitation.

[59]  W. Kubicek,et al.  Evaluation of pressure as a factor in the production of ischial ulcers. , 1958, Archives of physical medicine and rehabilitation.

[60]  M. Patrick,et al.  A National Study of Pressure Ulcer Prevalence and Incidence in Acute Care Hospitals , 2000, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[61]  M. Kosiak,et al.  Etiology and pathology of ischemic ulcers. , 1959, Archives of physical medicine and rehabilitation.

[62]  G. Yarkony,et al.  Pressure ulcers: a review. , 1994, Archives of physical medicine and rehabilitation.

[63]  T. Conine,et al.  Pressure Sore Prophylaxis in Elderly Patients Using Slab Foam or Customized Contoured Foam Wheelchair Cushions , 1993 .

[64]  William T. Cumming,et al.  Microprocessor-based weight shift monitors for paraplegic patients. , 1986, Archives of physical medicine and rehabilitation.

[65]  Thacker Jg,et al.  Three-dimensional computer model of the human buttocks, in vivo , 1994 .

[66]  Susan L Garber,et al.  Pressure ulcers in veterans with spinal cord injury: a retrospective study. , 2003, Journal of rehabilitation research and development.

[67]  D. Thomas,et al.  Prevention and treatment of pressure ulcers: what works? what doesn't? , 2001, Cleveland Clinic journal of medicine.

[68]  S M Peirce,et al.  Ischemia‐reperfusion injury in chronic pressure ulcer formation: A skin model in the rat , 2008, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[69]  C A Salzberg,et al.  Major risk factors for pressure ulcers in the spinal cord disabled: a literature review , 1996, Spinal Cord.

[70]  J. Greenleaf,et al.  Selected methods for imaging elastic properties of biological tissues. , 2003, Annual review of biomedical engineering.

[71]  M Hanlon,et al.  Reducing nosocomial pressure ulcers in an acute care facility. , 2000, Journal of nursing care quality.

[72]  J. Black,et al.  Moving Toward Consensus on Deep Tissue Injury and Pressure Ulcer Staging , 2005, Advances in skin & wound care.

[73]  O. Lindan,et al.  PRESSURE DISTRIBUTION ON THE SURFACE OF THE HUMAN BODY. I. EVALUATION IN LYING AND SITTING POSITIONS USING A "BED OF SPRINGS AND NAILS". , 1965, Archives of physical medicine and rehabilitation.

[74]  C G Cayten,et al.  A new pressure ulcer risk assessment scale for individuals with spinal cord injury. , 1996, American journal of physical medicine & rehabilitation.

[75]  R. Allman,et al.  Pressure ulcer prevalence, incidence, risk factors, and impact. , 1997, Clinics in geriatric medicine.

[76]  A Pedotti,et al.  Comparative biomechanical evaluation of different wheelchair seat cushions. , 2000, Journal of rehabilitation research and development.

[77]  Garber Sl,et al.  A system for clinically evaluating wheelchair pressure-relief cushions. , 1978 .

[78]  A Gefen,et al.  Mechanical compression-induced pressure sores in rat hindlimb: muscle stiffness, histology, and computational models. , 2004, Journal of applied physiology.

[79]  Cwj Cees Oomens,et al.  Quantification and localisation of damage in rat muscles after controlled loading; a new approach to study the aetiology of pressure sores. , 2001, Medical engineering & physics.

[80]  R. Daniel,et al.  Etiologic factors in pressure sores: an experimental model. , 1981, Archives of physical medicine and rehabilitation.

[81]  P. New,et al.  Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact. , 2004, Archives of physical medicine and rehabilitation.

[82]  Shuichi Kuroda,et al.  Finite element analysis of undermining of pressure ulcer with a simple cylinder model. , 2005, Journal of Nippon Medical School = Nippon Ika Daigaku zasshi.

[83]  P Dabnichki,et al.  Pressure variation under the ischial tuberosity during a push cycle. , 1998, Medical engineering & physics.

[84]  S V Fisher,et al.  Pressure and temperature patterns under the ischial tuberosities. , 1980, Bulletin of prosthetics research.

[85]  R. Halfens,et al.  Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics. , 2006, Ostomy/wound management.

[86]  M R Drost,et al.  Passive transverse mechanical properties of skeletal muscle under in vivo compression. , 2001, Journal of biomechanics.

[87]  G V Cochran,et al.  Model experiments to study the stress distributions in a seated buttock. , 1982, Journal of biomechanics.

[88]  N P Reddy,et al.  Stress distribution in a physical buttock model: effect of simulated bone geometry. , 1992, Journal of biomechanics.

[89]  T. Husain,et al.  An experimental study of some pressure effects on tissues, with reference to the bed-sore problem. , 1953, The Journal of pathology and bacteriology.

[90]  A. Gefen,et al.  Real-Time Patient-Specific Finite Element Analysis of Internal Stresses in the Soft Tissues of a Residual Limb: A New Tool for Prosthetic Fitting , 2006, Annals of Biomedical Engineering.

[91]  D. Berlowitz,et al.  Pressure‐Related Deep Tissue Injury under Intact Skin and the Current Pressure Ulcer Staging Systems , 2005, Advances in skin & wound care.

[92]  D. Langemo,et al.  Coming to consensus on deep tissue injury. , 2005, Advances in skin & wound care.

[93]  E Trefler,et al.  The relationship between pressure ulcer incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair users. , 2001, Archives of physical medicine and rehabilitation.