title: Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E.
abstract: The pathogenesis of the development of pressure ulcers is still unclear. The aim of this study was to investigate the role of ischaemia and reperfusion in pressure-induced tissue necrosis in the trochanteric region in pigs. Pressure application was achieved with a newly developed computer-controlled pressure device. Histological examination showed damage in the subcutis and muscle tissue comparable with inflammation, extending in a vascular pattern beyond the area of pressure application. Electron-microscopic studies revealed neutrophil adherence to the capillary endothelium, which showed signs of injury. These observations were manifest two hours after the cessation of pressure. Pre-treatment with 500 mg vitamin E per day resulted in significantly less tissue damage compared with untreated animals. Pressure alone caused a significant decrease in reduced glutathione and total glutathione, suggesting oxidative stress. After pressure release there was a significant increase in hydrogen peroxide concentration, suggesting a decreased antioxidant protection. After pre-treatment with vitamin E, however, there was no increase of hydrogen peroxide. It is concluded that the early signs of necrosis after pressure application are concordant with typical ischaemia-reperfusion damage and this can be prevented in part by treatment with vitamin E. Prophylactic administration of vitamin E may influence the occurrence of pressure ulcers in humans undergoing elective surgery.
authors.affiliation: Department of Dermatology, University Hospital Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Houwing
authors.forename: M
authors.initials: M
authors.lastname: Overgoor
authors.forename: M
authors.initials: M
authors.lastname: Kon
authors.forename: G
authors.initials: G
authors.lastname: Jansen
authors.forename: B S
authors.initials: BS
authors.lastname: van Asbeck
authors.forename: J R
authors.initials: JR
authors.lastname: Haalboom
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D009336:Necrosis; D003668:Pressure Ulcer / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D013552:Swine; D014810:Vitamin E / Q000627:therapeutic use*
chemical_list: D014810:Vitamin E