FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Wednesday August 31st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Pressure Ulcers - Can biomechanical research inform clinical practice?
Dan Bader 1,2*
1* School of Health Sciences, University of Southampton, UK, D.L.Bader@soton.ac.uk
2 Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
Introduction
Biomechanical research has clearly been successful in
many clinical fields, particularly those associated with
orthopaedics and cardiovascular medicine. Indeed it
can provide an objective differential diagnosis of a
patient presenting at a clinic, and an assessment of
the effectivenes of conservative and surgical
management and rehabilitation strategies A similar
biomechanical approach has also been envisaged in
analysing the complex issues associated with pressure
ulcers. As an example, for years the traditional
mechanism associated with its aetiology was based on
the concept of biomechanical-induced ischemia.
However in the last decade we have been able to
propose alternative mechanisms influenced by
biomechanics, which evoke soft tissue breakdown,
including cell and tissue deformation, ischaemicreperfusion
injury and impaired interstitial and
lymphatic flows [1]. This has necessitated an
hierarchical approach from cell-based studies, to
tissue and animal models [2] to human investigations.
The former provide a means of examining specific
biomechanical effects using controlled cell-based
experiments [3]. However, it is still problematic to
extrapolate these findings to a clinical setting.
The presentation will evaluate what has been learned
from these biomechanical approaches to inform
clinical practice. In many cases, they have highlighted
the need for caution, for example, in the use of
pressure maps alone to evaluate the loaded interface,
the establishment of a universal safe pressure levels
and in the consideration of local tissue biomechanics.
Nonetheless, there is considerable grounds for
optimism that from a biomechanical point of view, we
are now in a position to provide objective guidelines for
the clinician who is directly involved in the prevention
and treatment of pressure ulcers. Indeed the
presentation will emphasize the importance of new
biotechnologies, which could be adapted for use in
identifying those patients at particular risk of
developing pressure ulcers and providing them with
personalized support systems. This can only be
achieved by a multidisciplinary team involving
scientists, clinicians and industry.
Acknowledgements
I gratefully appreciate the help of many collaborators
that have shared my passion for pressure ulcer
research over many years. Special thanks must go to
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my long time colleague in Eindhoven, Dr Cees
Oomens, the current president of EPUAP.
References
[1] Bouten et al. Archives Physical Medicine
Rehabilitation 84: 616-619, 2003
[2] Loerakker et al. Annals Biomedical Engineering.
38(8):2577-87, 2010
[3] Gawlitta et al. Annals Biomedical Engineering.
35(2): 273-84, 2007
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