The mechanobiology theory of the development of medical device-related pressure ulcers revealed through a cell-scale computational modeling framework

Adi Lustig, Raz Margi, Aleksei Orlov, Daria Orlova, Liran Azaria, Amit Gefen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations

Abstract

Pressure ulcers are localized sites of tissue damage which form due to the continuous exposure of skin and underlying soft tissues to sustained mechanical loading, by bodyweight forces or because a body site is in prolonged contact with an interfacing object. The latter is the common cause for the specific sub-class of pressure ulcers termed ‘medical device-related pressure ulcers’, where the injury is known to have been caused by a medical device applied for a diagnostic or therapeutic purpose. Etiological research has established three key contributors to pressure ulcer formation, namely direct cell and tissue deformation, inflammatory edema and ischemic damage which are typically activated sequentially to fuel the injury spiral. Here, we visualize and analyze the above etiological mechanism using a new cell-scale modeling framework. Specifically, we consider here the deformation-inflicted and inflammatory contributors to the damage progression in a medical device-related pressure ulcer scenario, forming under a continuous positive airway pressure ventilation mask at the microarchitecture of the nasal bridge. We demonstrate the detrimental effects of exposure to high-level continuous external strains, which causes deformation-inflicted cell damage almost immediately. This in turn induces localized edema, which exacerbates the cell-scale mechanical loading state and thereby progresses cell damage further in a nonlinear, escalating pattern. The cell-scale quantitative description of the damage cascade provided here is important not only from a basic science perspective, but also for creating awareness among clinicians as well as industry and regulators with regards to the need for improving the design of skin-contacting medical devices.

Original languageEnglish
Pages (from-to)851-860
Number of pages10
JournalBiomechanics and Modeling in Mechanobiology
Volume20
Issue number3
DOIs
StatePublished - Jun 2021

Funding

FundersFunder number
Ministry of Science and Technology, Israel3-17421

    Keywords

    • Cell and tissue deformations
    • Cell death
    • Inflammatory edema
    • Pressure injuries
    • Sustained mechanical loading

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