Weight‐bearing–induced changes in the microtopography and structural stiffness of human skin in vivo following immobility periods

Abstract

Pressure ulcers (PUs) are injuries to the skin and underlying tissues, caused by sustained deformations and occur frequently in aged patients. Skin microtopography and stiffness affect the interaction of skin with contact surfaces contributing to PU development. We simulated immobility in 20 healthy females (mean age 69.9 years). Skin microtopography and stiffness were measured at the PU predilection sites before and after loading. Skin roughness decreased at the heels by 18.1% after 90 minutes (p = 0.022), but remained unchanged at the sacrum and the upper back. Structural elasticity and elastic deformations increased at all skin areas; changes over time were significant at the sacrum (p = 0.005) and the heel, (p = 0.002). The residual skin deformation increased at all skin areas after loading significantly at the sacrum (32.0%, p = 0.013) and upper back (20.6%, p = 0.007). The structural "biological" elasticity of the skin decreased significantly at the upper back after loading, but remained unchanged at the heels. All skin changes recovered after unloading. Results indicate that prolonged loading causes structural skin changes in humans in vivo in PU predilection sites. The pathogenesis of PUs is different at the heels, the sacral and upper back skin.

Comparing the effects of 3 different pressure ulcer prevention support surfaces on the structure and function of heel and sacral skin: An exploratory cross‐over trial

“…Results of the stiffness, elasticity, and topography measurements are shown in Table . Baseline values were similar to previous study results, and heel skin was stiffer and less elastic compared with sacral skin. Immediately after loading, the maximum extensibility (Uf) was higher compared with baseline, indicating decreased stiffness.…”

“…The structural stiffness decreased slightly, indicating higher pliability due to loading. These results are supported by previous research and could be associated with the increased hydration . For the elastic function and the ability to recover, we observed a slight decrease for the foam mattress compared with the other 2 support surfaces, indicating possible higher structural changes due to higher deformation.…”

“…The interaction between skin function and fabrics (eg, bed sheets, clothing) is also well known . It has also been previously demonstrated that prolonged loading on a standard hospital foam mattress leads to a broad range of structural and functional skin changes on loaded heel and sacral skin . PU preventive support surfaces in general modify the degree of skin and tissue deformation and microclimate at the same time.…”

Reproducibility analysis on shear wave elastography (SWE)-based quantitative assessment for skin elasticity

“…The skin tension is higher in lower leg than abdomen. [17] Volunteers’ individual variations may also be responsible for the obvious standard deviations. In order to improve the comparability on skin SWE, an ideal testing area is required a low variety zone.…”

Using ultrasound elastography to monitor human soft tissue behaviour during prolonged loading: A clinical explorative study

“…This was part of a larger study focussing on skin structural and functional parameters during prolonged loading [26,27]. Among others, inclusion criteria were (1) female gender, (2) age 60e80 years, (3) ability to sit, lie, and move independently for prolonged periods of time, and (4) written informed consent.…”