A review of deep tissue injury development, detection, and prevention: Shear savvy

Amit Gefen*, Karen J. Farid, Ira Shaywitz, Xiaohong Zhong, Takashi Nagase, Lijuan Huang, Toshiko Kaitani, Shinji Iizaka, Yuko Yamamoto, Toshiki Kanazawa, Hiromi Sanada, Stephannie Miller, Michael Parker, Nicole Blasiole, Nancy Beinlich, Judith Fulton

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Pressure ulcer prevention strategies include the prevention, and early recognition, of deep tissue injury (DTI), which can evolve into a Stage III or Stage IV pressure ulcer. In addition to their role in pressure-induced ischemia, shearing forces are believed to contribute substantially to the risk of DTI. Because the visual manifestation of a DTI may not occur until many hours after tissues were damaged, research to explore methods for early detection is on-going. For example, rhabdomyolysis is a common complication of deep tissue damage; its detection via blood chemistry and urinalysis is explored as a possible diagnostic tool of early DTI in anatomical areas where muscle is present. Substances released from injured muscle cells have a predictable time frame for detection in blood and urine, possibly enabling the clinician to estimate the time of the tissue death. Several small case studies suggest the potential validity and reliability of ultrasoun for visualizing soft tissue damage also deserve further research. While recommendations to reduce mechanical pressure and shearing damage in high-risk patients remain unchanged, their implementation is not always practical, feasible, or congruent with the overall plan of patient care. Early detection of existing tissue damage will help clinicians implement appropriate care plans that also may prevent further damage. Research to evaluate the validity, reliability, sensitivity, and specificity of diagnostic studies to detect pressure-related tissue death is warranted.

Original languageEnglish
JournalOstomy Wound Management
Issue number2
StatePublished - Feb 2013


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