Pressure ulcers in SCI: does tension stimulate wound healing?

Pressure ulcers are an immense problem among older and disabled populations. Although there are many studies in the literature about the etiology, interface pressures, natural history, and epidemiology of skin breakdown, there is relatively little information about factors that stimulate the repair of body wall tissues after breakdown. Specifically, there is a paucity of information about the effects of mechanical stress on healing. This is a particularly important consideration for those areas, such as the perineal tissues, that bear large mechanical forces. The purpose of this paper is to discuss the research that addresses skin and tissue repair in response to tension. Two case studies that support the hypothesis that tension stimulates wound healing are presented from the Spinal Cord Injury Center at the Seattle VAMC. After weeks of nonhealing, each of these cases healed within 2 weeks of initiating a range of motion program that applied tension to the nonhealing portion of a myocutaneous flap.