Challenges to measure hydration, redness, elasticity and perfusion in the unloaded sacral region of healthy persons after supine position.

AIM OF THE STUDY To combine measurement methods of biophysical skin properties in a clinical setting and to measure baseline values in the unloaded sacral region of healthy persons after lying 30 min in supine position. METHODS Hydration (Corneometer® CM 825), redness (Mexameter® MX 18), elasticity (Cutometer® MPA 580) and perfusion (PeriFlux System 5000) of the skin in the sacral region of 10 healthy participants (median age: 26.9 years) were measured consecutively in the laying position by two trained examiners. RESULTS The assessment duration for all four parameters lasted about 15 min. Intra-class correlation coefficients were overall moderate to strong (hydration r = 0.594, redness r = 0.817, elasticity r = 0.719, perfusion r = 0.591). Hydration (median 27.7 arbitrary units (AU)) mainly indicated dry skin conditions. Redness (median 158.5 AU) was low. Elasticity (median 0.880 AU) showed similar values as in the neck region. Perfusion (median 17.1 AU) showed values in the range of results reported in the literature. CONCLUSION Biophysical skin properties in the sacral region after supine position can be measured within periods of 15 min. The results provide baseline data for the skin of healthy persons as well as insights into skin-physiological variations. But it remains challenging to optimize measurement procedures and test protocols when transferring preclinical tests in a clinical application.

[1]  E. Thorsen,et al.  Reproducibility of transcutaneous oximetry and laser Doppler flowmetry in facial skin and gingival tissue. , 2010, Microvascular research.

[2]  Young Hyun Joo,et al.  Influence of age and regional differences on skin elasticity as measured by the Cutometer® , 2008, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[3]  S. Derler,et al.  Tribology of Skin: Review and Analysis of Experimental Results for the Friction Coefficient of Human Skin , 2011, Tribology Letters.

[4]  L. Parish,et al.  The decubitus ulcer: many questions but few definitive answers. , 2007, Clinics in dermatology.

[5]  Kath M Bogie,et al.  Pressure ulcer management and research priorities for patients with spinal cord injury: consensus opinion from SCI QUERI Expert Panel on Pressure Ulcer Research Implementation. , 2011, Journal of rehabilitation research and development.

[6]  K. Wilhelm,et al.  Guidelines for measurement skin colour and erythema A report from the Standardization Group of the European Society of Contact Dermatitis * , 1996, Contact dermatitis.

[7]  Tamara Reid Bush,et al.  Blood perfusion and transcutaneous oxygen level characterizations in human skin with changes in normal and shear loads--implications for pressure ulcer formation. , 2010, Clinical biomechanics.

[8]  J. Kottner,et al.  Relation between pressure, friction and pressure ulcer categories: a secondary data analysis of hospital patients using CHAID methods. , 2011, International journal of nursing studies.

[9]  M. Naghizadeh,et al.  Variation of Biophysical Parameters of the Skin with Age, Gender, and Body Region , 2012, TheScientificWorldJournal.

[10]  Yih-Kuen Jan,et al.  Comparison of changes in heart rate variability and sacral skin perfusion in response to postural changes in people with spinal cord injury. , 2013, Journal of rehabilitation research and development.

[11]  M. Post,et al.  Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation , 2011, Spinal Cord.

[12]  N. Turhan,et al.  Clinical and Epidemiologic Evaluation of Pressure Ulcers in Patients at a University Hospital in Turkey , 2007, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[13]  S Derler,et al.  Skin–textile friction and skin elasticity in young and aged persons , 2009, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[14]  P. Clarys,et al.  Skin color measurements: comparison between three instruments: the Chromameter®, the DermaSpectrometer® and the Mexameter® , 2000, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[15]  S. Bielfeldt,et al.  Multicentre comparison of skin hydration in terms of physical‐, physiological‐ and product‐dependent parameters by the capacitive method (Corneometer CM 825) , 2003, International journal of cosmetic science.

[16]  Paul van Zuijlen,et al.  Objective Color Measurements: Clinimetric Performance of Three Devices on Normal Skin and Scar Tissue , 2013, Journal of burn care & research : official publication of the American Burn Association.

[17]  Jm Mcquillan,et al.  international review , 1979 .

[18]  S Derler,et al.  Influence of epidermal hydration on the friction of human skin against textiles , 2008, Journal of The Royal Society Interface.

[19]  M. Engström,et al.  Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients. , 2013, Journal of advanced nursing.

[20]  Fuyuan Liao,et al.  Effect of durations of wheelchair tilt-in-space and recline on skin perfusion over the ischial tuberosity in people with spinal cord injury. , 2013, Archives of physical medicine and rehabilitation.

[21]  H. Stähelin,et al.  Influence of the 30 degrees laterally inclined position and the 'super-soft' 3-piece mattress on skin oxygen tension on areas of maximum pressure--implications for pressure sore prevention. , 1986, Gerontology.

[22]  H. Mccreath,et al.  Assessing the feasibility of subepidermal moisture to predict erythema and stage 1 pressure ulcers in persons with spinal cord injury: A pilot study , 2012, The journal of spinal cord medicine.

[23]  T. Shimada,et al.  Morphological architecture and distribution of blood capillaries and elastic fibres in the human skin. , 2001, Journal of tissue viability.

[24]  T. Bush,et al.  Quantifying the effects of external shear loads on arterial and venous blood flow: implications for pressure ulcer development. , 2013, Clinical biomechanics.

[25]  C Fattal,et al.  Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage , 2009, Spinal Cord.

[26]  J. Nixon,et al.  A systematic review of risk factors for the development and recurrence of pressure ulcers in people with spinal cord injuries , 2013, Spinal Cord.

[27]  T. Senderovitz,et al.  Females have lower skin surface pH than men , 2001, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[28]  J. Fluhr,et al.  Full-Body Skin Mapping for Six Biophysical Parameters: Baseline Values at 16 Anatomical Sites in 125 Human Subjects , 2011, Skin Pharmacology and Physiology.

[29]  C. Hürny,et al.  Assessment of Biophysical Skin Properties at Different Body Sites in Hospitalized Old Patients: Results of a Pilot Study , 2012, Gerontology.

[30]  R. A. Knutson,et al.  Use of Sugar and Povidone‐Iodine to Enhance Wound Healing: Five Years' Experience , 1981, Southern medical journal.

[31]  Alberto A. C. C. Pais,et al.  In vivo friction study of human skin: Influence of moisturizers on different anatomical sites , 2007 .

[32]  Fuyuan Liao,et al.  Skin blood flow dynamics and its role in pressure ulcers. , 2013, Journal of tissue viability.

[33]  N. Krueger,et al.  Age‐related changes in skin mechanical properties: a quantitative evaluation of 120 female subjects , 2011, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[34]  L. Portney,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[35]  C. Fattal,et al.  Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages , 2009, Spinal Cord.

[36]  H. Maibach,et al.  Skin aging. Effect on transepidermal water loss, stratum corneum hydration, skin surface pH, and casual sebum content. , 1991, Archives of dermatology.

[37]  Ming Zhang,et al.  Biomechanics of pressure ulcer in body tissues interacting with external forces during locomotion. , 2010, Annual review of biomedical engineering.

[38]  D L Bader,et al.  The physiological response of skin tissues to alternating support pressures in able-bodied subjects. , 2013, Journal of the mechanical behavior of biomedical materials.

[39]  A. Libin,et al.  Skin Microvascular and Metabolic Response to Sitting and Pressure Relief Maneuvers in People With Spinal Cord Injury , 2011 .

[40]  Jae Woo Choi,et al.  The influences of skin visco‐elasticity, hydration level and aging on the formation of wrinkles: a comprehensive and objective approach , 2013, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[41]  J. Woods,et al.  Using reactive hyperemia to assess the efficacy of local cooling on reducing sacral skin ischemia under surface pressure in people with spinal cord injury: a preliminary report. , 2013, Archives of physical medicine and rehabilitation.

[42]  David R. Thomas,et al.  Prevention and treatment of pressure ulcers. , 2006, Journal of the American Medical Directors Association.

[43]  M Roustit,et al.  Reproducibility and methodological issues of skin post-occlusive and thermal hyperemia assessed by single-point laser Doppler flowmetry. , 2010, Microvascular research.

[44]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[45]  J. Nunnally,et al.  Psychometric Theory: NY. , 1978 .

[46]  P. Lachenbruch,et al.  The relative contributions of interface pressure, shear stress, and temperature on tissue ischemia: a cross-sectional pilot study. , 2013, Ostomy/wound management.

[47]  Leslie G. Portney Dpt PhD Fapta,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[48]  M L Boninger,et al.  Comparison of skin perfusion response with alternating and constant pressures in people with spinal cord injury , 2011, Spinal Cord.

[49]  Tonny Karlsmark,et al.  Evaluation of four non‐invasive methods for examination and characterization of pressure ulcers , 2008, Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging.

[50]  E. Berardesca,et al.  Comparative study of five instruments measuring stratum corneum hydration (Corneometer CM 820 and CM 825, Skicon 200, Nova DPM 9003, DermaLab). Part I. In vitro , 1999 .

[51]  Mary Jo Geyer,et al.  Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure. , 2008, Archives of physical medicine and rehabilitation.

[52]  Ming Zhang,et al.  Wavelet analysis of sacral tissue oxygenation oscillations by near-infrared spectroscopy in persons with spinal cord injury. , 2011, Microvascular research.