Abstract
Soft tissue breakdown is a major cause of disablement in the United States. External pressure has been the most frequently discussed stress factor in the formation of ulcers. Analysis of published data on the prevalence of pressure ulcers and interface pressures at various anatomic sites indicate a nearly non-existent or slightly negative correlation between prevalence and interface pressure for the general and the spinal cord injured populations respectively. This lack of direct relation suggests the major influence of environmental factors in addition to mechanical factors (pressure, shear strain and friction, etc.,) on ulcer formation and indicates the need for control of the support surface microenvironment. However, most of the reported results from studies evaluating support surfaces focus mainly on pressure relief and neglect to address adequately the environmental contributing factors of ulcer formation. Studies directly relating primary stress factors and tissue viability with prevalence and incidence of pressure ulcers are needed to better understand the benefits of pressure relieving support surfaces and to improve the effectiveness of prevention and treatment interventions. The effects of microenvironment on support surface function are reviewed here to aid the healthcare providers in the choosing of the most appropriate support surface to meet the patient’s needs.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Lyder, C.H.: Pressure ulcer prevention and management. JAMA 289(2), 223–226 (2003)
Allman, R.M.: Pressure sores among the elderly. N. Engl. J. Med. 320(13), 850–853 (1989)
Kuhn, B.A., Coulter, S.J.: Balancing the pressure ulcer cost and quality equation. Nurs. Econ. 10(5), 353–359 (1992)
Miller, H., Delozier, J.: Cost implications of the pressure ulcer treatment guideline. Columbia, MD: Center for Health Policy Studies; Contract No. 282-91-0070. Sponsored by the Agency for Health Care Policy and Research (1994)
Whittington, K.T., Briones, R.: National Prevalence and Incidence Study: 6-year sequential acute care data. Adv. Skin Wound Care 17(9), 490–494 (2004)
Landis, E.M.: The microinjection studies of capillary blood pressure in human skin. Heart 15, 209–228 (1930)
National Pressure Ulcer Advisory Panel, http://www.npuap.org/pr2.htm (accessed May 12, 2009)
Russell, L.: Overview of research to investigate pressure-relieving surfaces. Br. J. Nurs. 10(21), 1421–1426 (2001)
Lilla, J.A., Friedrichs, R.R., Vistnes, L.M.: Floatation mattresses for preventing tissue breakdown. Geriatrics 30(9), 71–75 (1975)
Boorman, J.G., Carr, S., Kemble, J.V.: A clinical evaluation of the air-fluidised bed in a general plastic surgery unit. Br. J. Plast. Surg. 34(2), 165–168 (1981)
Berijan, R.A., Douglas, H.O., Holyoke, E.D., et al.: Skin pressure measurements on various mattress surfaces in cancer patients. Am. J. Phys. Med. 62(5), 217–226 (1983)
Bar, C.A.: Evaluation of cushions using dynamic press measurement. Prosthet. Orthot. Int. 15(3), 232–240 (1991)
Allen, V., Ryan, D.W., Murray, A.: Repeatability of subject/bed interface pressure measurements. J. Biomed. Eng. 15(4), 329–332 (1993)
Hedrick-Thompson, J., Halloran, T., Strader, M.K., McSweeney, M.: Pressure-reduction products: making appropriate choices. J. ET. Nurs. 20(6), 239–244 (1993)
Allen, V., Ryan, D.W., Murray, A.: Measurements of interface pressure between body sites and the surfaces of four specialized air mattresses. British Journal of Clinical Practice 48(3), 125–129 (1994)
Collier, M.E.: Pressure-reducing mattresses. Journal of Wound Care 5(5), 207–211 (1996)
Sachse, R.E., Fink, S.A., Klitzman, B.: Multimodality evaluation of pressure relief surfaces. Plastic and Reconstructive Surgery 102(7), 2381–2387 (1998)
Fontaine, R., Risley, S., Castellino, R.: A quantitative analysis of pressure and shear in the effectiveness of support surfaces. J. Wound Ostomy Continence Nurs. 25(5), 233–239 (1998)
Hardin, J.B., Cronin, S.N., Cahill, K.: Comparison of the effectiveness of two pressure-relieving surfaces: low-air-loss versus static fluid. Ostomy Wound Manage 46(9), 50–56 (2000)
Russo, C.A., Elixhauser, A. (2006) Hospitalizations Related to Pressure Sores. HCUP Statistical Brief #3. Agency for Healthcare Research and Quality, Rockville, MD (2003), http://www.hcup-us.ahrq.gov/reports/statbriefs/sb3.pdf (accessed May 2, 2006)
Gefen, A., Levine, J.: The false premise in measuring body-support interface pressures for preventing serious pressure ulcers. J. Med. Eng. Technol. 31(5), 375–380 (2007)
Makhsous, M., Rowles, D.M., Rymer, W.Z., et al.: Periodically relieving ischial sitting load to decrease the risk of pressure ulcers. Arch. Phys. Med. Rehabil. 88(7), 862–870 (2007)
Nicosia, G., Gliatta, A.E., Woodbury, M.G., Houghton, P.E.: The effect of pressure-relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta-analysis. Int. Wound J. 4(3), 197–207 (2007)
Berlowitz, D.R., Brienza, D.M.: Are all pressure ulcers the result of deep tissue injury? A review of the literature. Ostomy Wound Manage 53(10), 34–38 (2007)
Bader, D.L., White, S.H.: The viability of soft tissues in elderly subjects undergoing hip surgery. Age Ageing 27(2), 217–221 (1998)
Reger, S.I., McGovern, T.R.F., Chung, K.C.: Biomechanics of tissue distortion and stiffness by magnetic resonance imaging. In: Bader, D. (ed.) Pressure Sores - Clinical Practice and Scientific Approach, ch. 14, pp. 177–190. MacMillan, London (1990)
Reger, S.I., Ranganathan, V.K., Sahgal, V.: Support surface interface pressure, microenvironment, and the prevalence of pressure ulcers: an analysis of the literature. Ostomy Wound Manage 53(10), 50–58 (2007)
Reichel, S.M.: Shear force as a factor in decubitus ulcers in paraplegics. J. Am. Med. Assoc. 166(7), 762–763 (1958)
Kokate, J.Y., Leland, K.J., Held, A.M., et al.: Temperature-modulated pressure ulcers: a porcine model. Arch. Phys. Med. Rehabil. 76(7), 666–673 (1995)
Parish, L.C., Lowthian, P., Witkowski, J.A.: The decubitus ulcer: many questions but few definitive answers. Clin. Dermatol. 25(1), 101–108 (2007)
Bennett, L., Kavner, D., Lee, B.Y., Trainor, F.S.: Shear vs. pressure as causative factors in skin blood flow occlusion. Arch. Phys. Med. Rehabil. 60, 309–314 (1979)
Knox, D.M.: Core body temperature, skin temperature, and interface pressure. Relationship to skin integrity in nursing home residents. Adv. Wound Care 12(5), 246–252 (1999)
Cherry, G.W., Ryan, T.J.: Pathophysiolgy. In: Parish, L.C., Witkowski, J.A., Crissey, J.T. (eds.) The decubitus ulcer in clinical practice, pp. 33–43. Springer, Berlin (1997)
Jay, R.: Pressure and Shear: their effects on support surface choice. Ostomy Wound Manage 4(8), 36–45 (1995)
Lim, D., Lin, F., Hendrix, R.W., Moran, B., Fasanati, C., Makhsous, M.: Evaluation of a new sitting concept designed for prevention of pressure ulcer on the buttock using finite element analysis. Med. Biol. Eng. Comput. 45(11), 1079–1084 (2007)
Linder-Ganz, E., Shabshin, N., Itzchak, Y., Yizhar, Z., Siev-Ner, I., Gefen, A.: Strains and stresses in sub-dermal tissues of the buttocks are greater in paraplegics than in healthy during sitting. J. Biomech. 41(3), 567–580 (2008)
Sae-Sia, W., Wipke-Tevis, D.D., Williams, D.A.: The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury. Arch. Phys. Med. Rehabil. 88(12), 1673–1680 (2007)
Lachenbruch, C.: Skin cooling surfaces: estimating the importance of limiting skin temperature. Ostomy Wound Manage 51(2), 70–79 (2005)
Houwing, R.H., Arends, J.W., Canninga-van Dijk, M.R., Koopman, E., Haalboom, J.R.: Is the distinction between superficial pressure ulcers and moisture lesions justifiable? A clinical-pathologic study. Skin med. 6(3), 113–117 (2007)
Reger, S.I., Adams, T.C., Maklebust, J.A., Sahgal, V.: Validation test for climate control on air-loss supports. Arch. Phys. Med. Rehabil. 82(5), 597–603 (2001)
Scott, J.W.: The body temperature. In: Best, C.H., Taylor, B. (eds.) The Physiological Basis of Medical Practice, p. 895. The Williams and Wilkins Co., Baltimore (1961)
Struck, B.D., Wright, J.E.: Pressure ulcers and endothelial dysfunction: is there a link? J. Nutr. Elder. 26(3-4), 105–117 (2007)
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer Berlin Heidelberg
About this chapter
Cite this chapter
Reger, S.I., Ranganathan, V.K. (2009). The Importance of the Microenvironment of Support Surfaces in the Prevalence of Pressure Ulcers. In: Gefen, A. (eds) Bioengineering Research of Chronic Wounds. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-00534-3_4
Download citation
DOI: https://doi.org/10.1007/978-3-642-00534-3_4
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-00533-6
Online ISBN: 978-3-642-00534-3
eBook Packages: EngineeringEngineering (R0)