Which techniques to improve the early detection and prevention of pressure ulcers?

Abstract

Pressure ulcers are a serious health problem for people with mobility disorders, like elders in acute care, long-term care, and home care settings. It also concerns paraplegics, tetraplegics or persons with burned injuries. Pressure ulcers result in significant morbidity and mortality. Consequences are a high human suffering, with high cost in terms of treatment. Several risk factors have been identified for the development of pressure ulcers: they are classified into extrinsic and intrinsic factors. Extrinsic factors include interface pressure, shear forces, friction. Intrinsic factors are the nutritional state of the patient, its age, diseases. There is little information about the mechanism of the formation of pressure sores but it is agreed that it is a complex process. The difficulty of the prevention lies in the evaluation of these factors. It is an essential stage to optimize the preventative measures. Actually, no quantifiable parameters exist to predict the formation of a pressure ulcer. This article is aimed to propose new techniques developed for the early detection of pressure ulcers. First, extrinsic parameters as the interface pressure and its consequences on the mobility are investigated. A new actimeter is presented to monitor the movements of the patient. The second part is dedicated to the presentation of a new imaging technique which can help the physician to control tissue elasticity of the patient. The technique is called elastography, it is a 3D strain estimation of soft biological tissues. Finally, the last way of investigation is the combination of extrinsic and intrinsic factors evaluation for a most relevant earlier diagnosis. Before the description of these techniques, it is essential to understand the phenomenology associated to the development of pressure sores. Only in this way, new techniques can be developed.

Grafting with Cryopreserved Amniotic Membrane versus Conservative Wound Care in Treatment of Pressure Ulcers: A Randomized Clinical Trial

“…Patients with impaired mobility such as stroke, unconsciousness, or spinal cord injury are most vulnerable to pressure ulcers. The overall prevalence of pressure ulcers was 27% in long term [1][2][3]. Other factors such as old age, poor nutrition, poor sensation, urinary and fecal incontinence, and individuals with dementia or other cognitive disorders are susceptible to pressure ulcer [2][3][4].…”

“…The overall prevalence of pressure ulcers was 27% in long term [1][2][3]. Other factors such as old age, poor nutrition, poor sensation, urinary and fecal incontinence, and individuals with dementia or other cognitive disorders are susceptible to pressure ulcer [2][3][4]. Wounds usually heal in three phases including inflammatory phase, a proliferative phase with migration of fibroblasts and deposition of extracellular matrix, and a remodeling phase with cross-linking and reorganization of the collagen matrix [1,5].…”

“…The cost of healing in pressure ulcer is high and also it affects the quality of life. This event has a four-fold increased risk of death, especially among the elderly patients [3,6,7].…”

Pressure Ulcers in Pediatric Patients With Spinal Cord Injury

“…60,61,69 Bioimpedance spectrometers were proposed to identify the variations of complex electrical impedances consequent to pathological changes in the skin or underlying deep tissues. 71,72 Instruments that measure the frequency-dependent viscoelastic response of soft tissues are also being tested. The actimeter records the movement of the skin surface in contact with the underlying surface, whereas the recorded autonomic nervous system activity level represents the degree of patient discomfort.…”

“…71,72 Instruments that measure the frequency-dependent viscoelastic response of soft tissues are also being tested. 71 75 Ultrasound-based elastography has been investigated as a potential detector of tissue pathology by estimating the strain of the tissue and signaling excessively deformed regions in danger of ischemic injuries.…”