title: Compression-induced damage and internal tissue strains are related.
abstract: Prolonged mechanical loading of soft tissues adjacent to bony prominences can lead to degeneration of muscle tissue, resulting in a condition termed pressure-related deep tissue injury. This type of deep pressure ulcers can develop into a severe wound, associated with problematic healing and a variable prognosis. Limited knowledge of the underlying damage pathways impedes effective preventive strategies and early detection. Traditionally, pressure-induced ischaemia has been thought to be the main aetiological factor for initiating damage. Recent research, however, proposes tissue deformation per se as another candidate for initiating pressure-induced deep tissue injury. In this study, different strain parameters were evaluated on their suitability as a generic predictive indicator for deep tissue injury. With a combined animal-experimental numerical approach, we show that there is a reproducible monotonic increase in damage with increasing maximum shear strain once a strain threshold has been exceeded. This relationship between maximum shear strain and damage seems to reflect an intrinsic muscle property, as it applied across a considerable number of the experiments. This finding confirms that tissue deformation per se is important in the aetiology of deep tissue injury. Using dedicated finite element modeling, a considerable reduction in the inherent biological variation was obtained, leading to the proposal that muscle deformation can prove a generic predictive indicator of damage.
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Building W-hoog 4.11, 5600 MB Eindhoven, The Netherlands. karlienk@gmail.com
authors.forename: K K
authors.initials: KK
authors.lastname: Ceelen
authors.forename: A
authors.initials: A
authors.lastname: Stekelenburg
authors.forename: S
authors.initials: S
authors.lastname: Loerakker
authors.forename: G J
authors.initials: GJ
authors.lastname: Strijkers
authors.forename: D L
authors.initials: DL
authors.lastname: Bader
authors.forename: K
authors.initials: K
authors.lastname: Nicolay
authors.forename: F P T
authors.initials: FP
authors.lastname: Baaijens
authors.forename: C W J
authors.initials: CW
authors.lastname: Oomens
mesh_terms: D000818:Animals; D019245:Compressive Strength; D003198:Computer Simulation; D004195:Disease Models, Animal; D055119:Elastic Modulus; D005260:Female; D008954:Models, Biological; D010812:Physical Stimulation / Q000009:adverse effects*; D011312:Pressure; D003668:Pressure Ulcer / Q000209:etiology* / Q000503:physiopathology*; D051381:Rats; D013314:Stress, Mechanical