Yap TL, Alderden J, Lewis M, Taylor K, Fife CE, et al.
Advances in skin & wound care. Date of publication 2021 Mar 1;volume 34(3):157-164.
1. Adv Skin Wound Care. 2021 Mar 1;34(3):157-164. doi:
10.1097/01.ASW.0000732804.13066.30.
Angiosomal Vascular Occlusions, Deep-Tissue Pressure Injuries, and Competing
Theories: A Case Report.
Yap TL(1), Alderden J, Lewis M, Taylor K, Fife CE.
Author information:
(1)Tracey L. Yap, PhD, RN, WCC, CNE, FGSA, FAAN, is Associate Professor, Duke
University School of Nursing, Durham, North Carolina. Jenny Alderden, PhD, APRN,
CCRN, CCNS, is Assistant Professor, University of Utah College of Nursing, Salt
Lake City, Utah. MaryAnne Lewis, BSN, RN, CWOCN, is Pediatric Wound Nurse, Texas
Children's Hospital, The Woodlands, Texas. Kristen Taylor, MSN, RN, CCRN-K, is
Director of Critical Care, CHI St Luke's Hospital, The Woodlands. Caroline E.
Fife, MD, is Professor of Geriatrics, Baylor College of Medicine, Houston, Texas,
and Medical Director, CHI St Luke's Hospital Wound Clinic, The Woodlands.
Comment in
Adv Skin Wound Care. 2021 Jun 1;34(6):288-289.
ABSTRACT: Compression of the soft tissue between a support surface and a bony
prominence has long been the accepted primary mechanism of pressure injury (PrI)
formation, with the belief that said compression leads to capillary occlusion,
ischemia, and tissue necrosis. This explanation presupposes an "outside-in"
pathophysiologic process of tissue damage originating at the local capillary
level. Despite advances in prevention protocols, there remains a stubbornly
consistent incidence of severe PrIs including deep-tissue injuries, the latter
usually evolving into stage 4 PrIs with exposed bone or tendon. This article
presents just such a perioperative case with the aim of providing further
evidence that these more severe PrIs may result from ischemic insults of a named
vessel within specific vascular territories (labeled as angiosomes). Pressure is
indeed a factor in the formation of severe PrIs, but these authors postulate that
the occlusion occurred at the level of a named artery proximal to the lesion.
This vascular event was likely attributable to low mean arterial pressure. The
authors suggest that the terminology proposed three decades ago to call both
deep-tissue injuries and stage 4 PrIs "vascular occlusion pressure injuries"
should be the topic of further research and expert consensus.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
DOI: 10.1097/01.ASW.0000732804.13066.30
PMID: 33587477
