Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
J Wound Care. 2024 Sep 2;33(9):620-628. doi: 10.12968/jowc.2024.0023.
The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the . A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents.
The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices.
Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin.
This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.
最新版的《国际压疮/损伤预防与治疗临床实践指南》于 2019 年发布。此后不久，2020 年，第一版关注器械相关压疮/损伤的 SECURE 预防专家小组报告作为特刊在 上发表。2022 年又发布了第二版。本文综合总结了这些全球认可的共识文件中详细阐述的压疮/损伤（PU/Is）病因的最新认识。
本文综述中所回顾的文献专门针对与体重或医疗器械相关的 PU/Is 背景下，软组织长时间变形对细胞和组织活力的影响。
软组织长时间变形最初会导致细胞死亡和组织微观损伤，随着时间的推移，可能会发展为临床 PU/Is。也就是说，局部高组织变形或机械应力集中可能会在数分钟内造成微观损伤，但可能需要数小时的持续机械加载，才能使这种初始细胞和组织损伤变得可见并在临床上显现出来。浅层组织损伤主要源于脆弱或易损皮肤的过度剪切负荷。相比之下，更深的 PU/Is，即深部组织损伤，通常是由于身体部位在尖锐或弯曲的骨性突起上或在长时间与皮肤接触的刚性医疗器械下的软组织中的应力集中引起的。
本综述深入了解了 PU/Is 的病理生理学，表明其一级预防应侧重于减轻细胞和组织承受的应力集中。这一目标可以通过降低软组织中应力集中的强度，或减少软组织暴露于此类应力集中的时间来实现。
