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An evaluation of dermal microcirculatory occlusion under repeated mechanical loads: implication of lymphatic impairment in pressure ulcers

An evaluation of dermal microcirculatory occlusion under repeated mechanical loads: implication of lymphatic impairment in pressure ulcers
An evaluation of dermal microcirculatory occlusion under repeated mechanical loads: implication of lymphatic impairment in pressure ulcers
Pressure ulcers represent a significant challenge to individuals with compromised mobility, affecting their quality of life and causing a substantive burden on healthcare providers. They are caused by prolonged mechanical loads deforming the underlying soft tissues. However, the thresholds that result in impairment of dermal microvascular and lymphatic vessels is unknown. The present study was designed to characterise the simultaneous response of microvascular and lymphatic structures under repeated mechanical loading. The effects of two distinct loading/unloading cycles involving i) incremental loads of 30, 60 and 90mmHg and ii) repeated loads of 30, 30 and 30mmHg were evaluated on a cohort of able-bodied volunteers. Microvascular response involved the monitoring of transcutaneous gas tensions, while dermal lymphatic activity was estimated from Near Infrared Fluoroscopy Lymphatic Imaging. The respective responses were compared during each load cycle and thresholds for occlusion were explored. During incremental loading, changes in microvascular response were dependent on the magnitudes, with the lowest pressure (30mmHg) resulting in a reduction in transcutaneous oxygen tension only, while the highest pressure affected both oxygen and carbon dioxide values indicative of ischemia in most participants (54%). By contrast, lymphatics revealed near total occlusion at the lowest pressure of 30mmHg. Although there were inter-subject differences in the microvascular and lymphatic responses, temporal trends consistently revealed partial or full impairment under load, with complete recovery during off-loading. The study provided a simultaneous evaluation of microvascular and lymphatic response to repeated load cycles. The pressure required to cause local ischemia and lymphatic occlusion differed between individuals in the able-bodied cohort. This highlights the need for personalised care strategies, where patients are assessed and monitored depending on their individual tolerance to prolonged pressures.
1073-9688
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Crielaard, H
3954a7b4-40be-45a9-a896-0546e6b41ccd
Oomens, C
89c18447-a3d6-4779-84fd-ad9e0ac631be
Bader, Daniel
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Crielaard, H
3954a7b4-40be-45a9-a896-0546e6b41ccd
Oomens, C
89c18447-a3d6-4779-84fd-ad9e0ac631be
Bader, Daniel
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf

Worsley, Peter, Crielaard, H, Oomens, C and Bader, Daniel (2020) An evaluation of dermal microcirculatory occlusion under repeated mechanical loads: implication of lymphatic impairment in pressure ulcers. Microcirculation, 27 (7), [e12645]. (doi:10.1111/micc.12645).

Record type: Article

Abstract

Pressure ulcers represent a significant challenge to individuals with compromised mobility, affecting their quality of life and causing a substantive burden on healthcare providers. They are caused by prolonged mechanical loads deforming the underlying soft tissues. However, the thresholds that result in impairment of dermal microvascular and lymphatic vessels is unknown. The present study was designed to characterise the simultaneous response of microvascular and lymphatic structures under repeated mechanical loading. The effects of two distinct loading/unloading cycles involving i) incremental loads of 30, 60 and 90mmHg and ii) repeated loads of 30, 30 and 30mmHg were evaluated on a cohort of able-bodied volunteers. Microvascular response involved the monitoring of transcutaneous gas tensions, while dermal lymphatic activity was estimated from Near Infrared Fluoroscopy Lymphatic Imaging. The respective responses were compared during each load cycle and thresholds for occlusion were explored. During incremental loading, changes in microvascular response were dependent on the magnitudes, with the lowest pressure (30mmHg) resulting in a reduction in transcutaneous oxygen tension only, while the highest pressure affected both oxygen and carbon dioxide values indicative of ischemia in most participants (54%). By contrast, lymphatics revealed near total occlusion at the lowest pressure of 30mmHg. Although there were inter-subject differences in the microvascular and lymphatic responses, temporal trends consistently revealed partial or full impairment under load, with complete recovery during off-loading. The study provided a simultaneous evaluation of microvascular and lymphatic response to repeated load cycles. The pressure required to cause local ischemia and lymphatic occlusion differed between individuals in the able-bodied cohort. This highlights the need for personalised care strategies, where patients are assessed and monitored depending on their individual tolerance to prolonged pressures.

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An evaluation of dermal microcirculatory occlusion under repeated mechanical loads implication of lymphatic impairment in pressure ulcers - Accepted Manuscript
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Accepted/In Press date: 23 June 2020
e-pub ahead of print date: 30 June 2020

Identifiers

Local EPrints ID: 442049
URI: http://eprints.soton.ac.uk/id/eprint/442049
ISSN: 1073-9688
PURE UUID: 4f7f5aaf-b42a-4fe7-9dd8-801d926598d7
ORCID for Peter Worsley: ORCID iD orcid.org/0000-0003-0145-5042
ORCID for Daniel Bader: ORCID iD orcid.org/0000-0002-1208-3507

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Date deposited: 06 Jul 2020 16:31
Last modified: 09 Jan 2022 03:36

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Contributors

Author: Peter Worsley ORCID iD
Author: H Crielaard
Author: C Oomens
Author: Daniel Bader ORCID iD

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