Author(s) Gefen A

Journal EWMA Journal. Date of publication 2018 Oct 1;volume 19(2):7-13.

Abstract Pressure ulcers (PUs) are one of the largest unsolved medical complications today. The burden of PUs on society and healthcare cost continues to grow rapidly with the ageing population and spread of chronic diseases. The overall absence of advanced biomedical pressure ulcer prevention (PUP) technologies that assess risk and screen for PU formation in the clinic is concerning, especially in light of the progress being made in other fields of medicine. To develop such technologies, an in-depth understanding of the damage cascade resulting in PUs is necessary and is reviewed here in detail from a mechanobiological perspective. The paper describes the sequential and additive nature of the PU damage cascade. Specifically, the damage cascade includes the sequential damage associated with direct deformation, inflammatory response, and ischaemia. The additive nature of these damages highlights the importance of early detection of cell and tissue damage for PUP. Examples of current PUP technologies reviewed here include (i) biocapacitance measurements using a subepidermal moisture scanner, which identifies biophysical changes in tissue properties caused by early inflammation to aid in early detection and (ii) polymeric membrane dressings that prophylactically subdue the activity of nociceptive neurons to mitigate the impact and spread of inflammation. Development of these and other technology-based options to detect and mitigate PU-specific tissue changes caused by exposure to sustained deformations and the resulting inflammation and ischaemia is a timely and feasible endeavour for biomedical engineers and is anticipated to minimize the burden of PUs

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