editorial
From incontinence associated dermatitis to pressure ulcers
Subscription enquiries: Sally Boettcher, MA Healthcare Ltd, Jesses Farm, Snow Hill, Dinton, Salisbury SP3 5HN. Tel: 0800 137201 (UK) or +44 1722 716997 (overseas) fax: +44 (0)1722 716926 [email protected]
© 2014 MA Healthcare
ltd
T
here is growing interest, from research as well as product development and testing perspectives, in developing biomechanical models of the human skin in interaction with support surfaces. Particular focus is given to the effects of wetness on mechanical loads in skin, in order to understand potential inter-relationships between incontinence-associated dermatitis (IAD) and superficial pressure ulcers (SPUs), especially in high-risk patients, such as frail elderly or those with diabetes. For several years, we have successfully used mathematical and computational modelling to reveal these inter-relationships. The mathematical model incorporated the effects of wetness-related friction on shear loads and the resulting reduced strength of the wet skin, and simulated how the compromised skin is mechanically overloaded in shear by forces that are amplified in a moist environment.1 Using computational modelling, which allows more detailed simulations, we further modelled aged or diabetic skin, which differ in structure and mechanical properties.2 Several factors, all clearly associated with IAD, emerged as being responsible for decreasing the tolerance of skin to SPUs: (i) Increase in local skin temperature, which can be associated with inflammation; (ii) Rise in the skin-clothing or skin-support coefficient of friction (COF) due to the wetness, and; (iii) Wrinkling of the skin in the moist environment, which is related to vasoconstriction (and hence reduced skin perfusion). The mechanical load in the skin increases as the moisturecontents-related COF between the skin and the clothing or support rises, and this effect becomes more prominent as skin tissues become stiffer, which occurs either with normal ageing or in diabetes.3 It is expected that in the near future, such modelling will facilitate the design of new interventions to protect the skin, e.g. safer patient clothing and absorptive containments, lotions, creams, gels or sprays, dressings and support surfaces that consider optimisation of microclimate factors and neutralisation or clearance of urine and faeces. To conclude, IAD, which results in inflammation-related skin temperature rise, greater COF and skin wrinkling, increases shear loads in skin, and this becomes more pronounced when the skin is ageing or diabetic. This clarifies the biomechanical pathway from IAD to the onset of SPUs. Amit Gefen Professor of Biomedical Engineering j o u r n a l o f wo u n d c a r e v o l 2 3 , n o 7 , J U LY 2 0 1 4
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Prof Amit Gefen Department of Biomedical Engineering, Tel Aviv University, Israel
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www.markallengroup.com References 1 Gefen, A. How do microclimate factors affect the risk for superficial pressure ulcers: a mathematical modeling study. J Tissue Viability 2011; 20: 81–88. 2 Sopher, R., Gefen, A. Effects of skin wrinkles, age and wetness on mechanical loads in the stratum corneum as related to skin lesions. Med Biol Eng Comput 2011; 49: 97–105. 3 Shaked, E., Gefen, A. Modeling the effects of moisture-related skin-support friction on the risk for superficial pressure ulcers during patient repositioning in bed. Front Bioeng Biotechnol 2013; 1: 9.
Journal of Wound Care is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: +44 (0)20 7738 5454 Email: [email protected] Websites: www.journalofwoundcare.com © MA Healthcare Ltd, 2014. All rights reserved. No part of the Journal of Wound Care may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 0969-0700 Printed by Pensord Press Ltd, Blackwood, NP12 2YA
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
345
Journal of Wound Care.Downloaded from magonlinelibrary.com by 129.011.021.002 on July 5, 2015. For personal use only. No other uses without permission. . All rights reserved.
From incontinence associated dermatitis to pressure ulcers
Subscription enquiries: Sally Boettcher, MA Healthcare Ltd, Jesses Farm, Snow Hill, Dinton, Salisbury SP3 5HN. Tel: 0800 137201 (UK) or +44 1722 716997 (overseas) fax: +44 (0)1722 716926 [email protected]
© 2014 MA Healthcare
ltd
T
here is growing interest, from research as well as product development and testing perspectives, in developing biomechanical models of the human skin in interaction with support surfaces. Particular focus is given to the effects of wetness on mechanical loads in skin, in order to understand potential inter-relationships between incontinence-associated dermatitis (IAD) and superficial pressure ulcers (SPUs), especially in high-risk patients, such as frail elderly or those with diabetes. For several years, we have successfully used mathematical and computational modelling to reveal these inter-relationships. The mathematical model incorporated the effects of wetness-related friction on shear loads and the resulting reduced strength of the wet skin, and simulated how the compromised skin is mechanically overloaded in shear by forces that are amplified in a moist environment.1 Using computational modelling, which allows more detailed simulations, we further modelled aged or diabetic skin, which differ in structure and mechanical properties.2 Several factors, all clearly associated with IAD, emerged as being responsible for decreasing the tolerance of skin to SPUs: (i) Increase in local skin temperature, which can be associated with inflammation; (ii) Rise in the skin-clothing or skin-support coefficient of friction (COF) due to the wetness, and; (iii) Wrinkling of the skin in the moist environment, which is related to vasoconstriction (and hence reduced skin perfusion). The mechanical load in the skin increases as the moisturecontents-related COF between the skin and the clothing or support rises, and this effect becomes more prominent as skin tissues become stiffer, which occurs either with normal ageing or in diabetes.3 It is expected that in the near future, such modelling will facilitate the design of new interventions to protect the skin, e.g. safer patient clothing and absorptive containments, lotions, creams, gels or sprays, dressings and support surfaces that consider optimisation of microclimate factors and neutralisation or clearance of urine and faeces. To conclude, IAD, which results in inflammation-related skin temperature rise, greater COF and skin wrinkling, increases shear loads in skin, and this becomes more pronounced when the skin is ageing or diabetic. This clarifies the biomechanical pathway from IAD to the onset of SPUs. Amit Gefen Professor of Biomedical Engineering j o u r n a l o f wo u n d c a r e v o l 2 3 , n o 7 , J U LY 2 0 1 4
UK Personal subscription rates
Prof Amit Gefen Department of Biomedical Engineering, Tel Aviv University, Israel
Quarterly Direct Debit
£27
Annual Direct Debit
£107
Annual Credit Card
£112
2yr Annual Credit Card
£191
3yr Annual Credit Card
£269
Subscribe online: www.magsubscriptions.com Subscribe by phone: +44 (0) 1722 716997 For information on reprints, please ring Anthony Kerr on +44 (0)20 7501 6726
MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com References 1 Gefen, A. How do microclimate factors affect the risk for superficial pressure ulcers: a mathematical modeling study. J Tissue Viability 2011; 20: 81–88. 2 Sopher, R., Gefen, A. Effects of skin wrinkles, age and wetness on mechanical loads in the stratum corneum as related to skin lesions. Med Biol Eng Comput 2011; 49: 97–105. 3 Shaked, E., Gefen, A. Modeling the effects of moisture-related skin-support friction on the risk for superficial pressure ulcers during patient repositioning in bed. Front Bioeng Biotechnol 2013; 1: 9.
Journal of Wound Care is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: +44 (0)20 7738 5454 Email: [email protected] Websites: www.journalofwoundcare.com © MA Healthcare Ltd, 2014. All rights reserved. No part of the Journal of Wound Care may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 0969-0700 Printed by Pensord Press Ltd, Blackwood, NP12 2YA
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
345
Journal of Wound Care.Downloaded from magonlinelibrary.com by 129.011.021.002 on July 5, 2015. For personal use only. No other uses without permission. . All rights reserved.
