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Skin stiffness determined from occlusion of a horizontally running microvessel in response to skin surface pressure: a finite element study of sacral pressure ulcers

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Abstract

Pressure ulcers occur following sustained occlusion of microvessels at bony prominences under skin surface pressure (SSP). However, the mechanical conditions of the surrounding soft tissue leading to microvascular occlusion are not fully understood. This study determined the stiffness of homogenized skin with microvasculature at the sacrum that occludes microvessels at an SSP of 10 kPa (consistent with a standard mattress) and recovers from occlusion at 5 kPa (consistent with a pressure-redistribution mattress). We conducted two-dimensional finite element analyses under plane stress and plane strain conditions to determine the stiffness of the skin. The results for plane stress conditions show that the microvessel was occluded with a Young’s modulus of 23 kPa in response to an SSP of 10 kPa at the center of the sacrum and that the circulation recovered following a reduction in the SSP to 5 kPa. The resulting Young’s modulus is consistent with reported data. Our study indicates that the critical value of the SSP for microvascular occlusion is determined not only by the stiffness of homogenized skin with microvasculature but also by the intraluminal pressure, microvascular wall stiffness, and body support conditions.

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References

  1. Abaqus 6.12 Theory manual. SIMULIA

  2. Bader DL, Barnhill RL, Ryan TJ (1986) Effect of externally applied skin surface forces on tissue vasculature. Arch Phys Med Rehabil 67:807–811

    CAS  PubMed  Google Scholar 

  3. Burton AC (1951) On the physical equilibrium of small blood vessels. Am J Physiol 164:319–329

    CAS  PubMed  Google Scholar 

  4. Flynn C, Taberner A, Nielsen P (2011) Measurement of the force–displacement response of in vivo human skin under a rich set of deformations. Med Eng Phys 33:610–619

    Article  PubMed  Google Scholar 

  5. Fung YC (1993) Biomechanics: mechanical properties of living tissues, 2nd edn. Springer, New York, pp 360–363

    Book  Google Scholar 

  6. Gefen A (2007) Risk factors for a pressure-related deep tissue injury: a theoretical model. Med Biol Eng Comput 45:563–573

    Article  PubMed  Google Scholar 

  7. Gerhardt LC, Strassle V, Lenz A, Spencer ND, Derler S (2008) Influence of epidermal hydration on the friction of human skin against textiles. J R Soc Interface 5:1317–1328

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hagisawa S, Shimada T (2005) Skin morphology and its mechanical properties associated with loading. In: Bader D, Bouten C, Colin D, Oomens C (eds) Pressure ulcer research: current and future perspectives. Springer, Berlin, pp 161–185

    Chapter  Google Scholar 

  9. Hasegawa K (2008) How resting supinely affects the human body: relation between sacral region body pressure and skin blood flow/skin temperature. J Fukui Prefect Univ 30:191–202 (in Japanese)

    Google Scholar 

  10. Jee T, Komvopoulos K (2014) Skin viscoelasticity studied in vitro by microprobe-based techniques. J Biomech 47:553–559

    Article  CAS  PubMed  Google Scholar 

  11. Jonsson A, Lindén M, Lindgren M, Malmqvist L-Å, Bäcklund Y (2005) Evaluation of antidecubitus mattresses. Med Biol Eng Comput 43:541–547

    Article  CAS  PubMed  Google Scholar 

  12. Lanir Y (1987) Skin mechanics. In: Skalak J, Chien S (eds) Handbook of bioengineering. McGraw-Hill, New York, pp 11.1–11.25

    Google Scholar 

  13. Levy A, Kopplin K, Gefen A (2014) An air-cell-based cushion for pressure ulcer protection remarkably reduces tissue stresses in the seated buttocks with respect to foams: finite element studies. J Tissue Viability 23:13–23

    Article  PubMed  Google Scholar 

  14. Levy A, Kopplin K, Gefen A (2014) Computer simulations of efficacy of air-cell-based cushions in protecting against reoccurrence of pressure ulcers. J Rehabil Res Dev 51:1297–1319

    Article  PubMed  Google Scholar 

  15. Linder-Ganz E, Gefen A (2004) Mechanical compression-induced pressure sores in rat hindlimb: muscle stiffness, histology, and computational models. J Appl Physiol 96:2034–2049

    Article  CAS  PubMed  Google Scholar 

  16. Linder-Ganz E, Gefen A (2007) The effects of pressure and shear on capillary closure in the microstructure of skeletal muscles. Ann Biomed Eng 35:2095–2107

    Article  PubMed  Google Scholar 

  17. Linder-Ganz E, Shabshin N, Itzchak Y, Gefen A (2007) Assessment of mechanical conditions in sub-dermal tissues during sitting: a combined experimental-MRI and finite element approach. J Biomech 40:1443–1454

    Article  PubMed  Google Scholar 

  18. Mak AFT, Zhang M, Tam EWC (2010) Biomechanics of pressure ulcer in body tissues interacting with external forces during locomotion. Annu Rev Biomed Eng 12:29–53

    Article  CAS  PubMed  Google Scholar 

  19. Michishige Y, Mori M (2012) Appropriate lateral inclination angle for pressure relief in elderly hospitalized patients. Jpn J Press Ulcers 14:558–566 (in Japanese)

    Google Scholar 

  20. Miyashita S (ed) (2007) CT image anatomy handbook. Ohmsha, Tokyo, p 147 (in Japanese)

  21. Nakagawa N, Matsumoto M, Sakai S (2010) In vivo measurement of the water content in the dermis by confocal Raman spectroscopy. Skin Res Technol 16:137–141

    Article  PubMed  Google Scholar 

  22. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance (2014) Prevention and pressure ulcers: clinical practice guideline. Haesler E (ed), Cambridge Media, Perth, pp 18–21

  23. Ohura T, Hotta Y, Ishii Y, Okamoto Y (2005) A new risk measurement (OH scale) for pressure ulcers and its usefulness for screening and evaluating pressure ulcer patients in clinical practice. Jpn J Press Ulcers 7:761–772 (in Japanese)

    Google Scholar 

  24. Rohan PY, Badel P, Lun B, Rastel D, Avril S (2015) Prediction of the biomechanical effects of compression therapy on deep veins using finite element modelling. Ann Biomed Eng 43:314–324

    Article  PubMed  Google Scholar 

  25. Shilo M, Gefen A (2013) Identification of capillary blood pressure levels at which capillary collapse is likely in a tissue subjected to large compressive and shear deformations. Comput Methods Biomech Biomed Eng 15:59–71

    Article  Google Scholar 

  26. Shoham N, Levy A, Kopplin K, Gefen A (2015) Contoured foam cushions cannot provide long-term protection against pressure-ulcers for individuals with a spinal cord injury: modeling studies. Adv Skin Wound Care 28:303–316

    Article  PubMed  Google Scholar 

  27. Sopher R, Gefen A (2011) Effects of skin wrinkles, age and wetness on mechanical loads in the stratum corneum as related to skin lesions. Med Biol Eng Comput 49:97–105

    Article  PubMed  Google Scholar 

  28. Storakers B (1986) On material representation and constitutive branching in finite compressible elasticity. J Mech Phys Solids 34:125–145

    Article  Google Scholar 

  29. Takezono S, Tao K, Minamoto H, Inamura E (2007) An introduction to the theory of elasticity. Morikita Publishing, Tokyo, pp 107–114 (in Japanese)

  30. Then C, Menger J, Benderoth G, Alizadeh M, Vogl TJ, Hubner F, Silber G (2008) Analysis of mechanical interaction between human gluteal soft tissue and body supports. Technol Health Care 16:61–76

    CAS  PubMed  Google Scholar 

  31. Timoshenko SP, Goodier JN (1951) Theory of elasticity. McGraw-Hill, New York, pp 78–81

    Google Scholar 

  32. Tran HV, Charleux F, Rachik M, Ehrlacher A, Ho Ba Tho MC (2007) In vivo characterization of the mechanical properties of human skin derived from MRI and indentation techniques. Comput Methods Biomech Biomed Eng 10:401–407

    Article  CAS  Google Scholar 

  33. Wu JZ, Cutlip RG, Andrew ME, Dong RG (2007) Simultaneous determination of the nonlinear-elastic properties of skin and subcutaneous tissue in unconfined compression tests. Skin Res Technol 13:34–42

    Article  PubMed  Google Scholar 

  34. Xu F, Lu T (2011) Introduction to skin biothermomechanics and thermal pain. Springer, Beijing, pp 7–19

    Book  Google Scholar 

  35. Yamamoto Y, Doi Y, Akiyama Y, Izumi Y, Kimura H, Nishijima S (2008) Biomechanical simulation for prevention of pressure ulcers (1. FEM simulation). Trans Jpn Soc Med Biol Eng 46:489–494 (in Japanese)

    Google Scholar 

  36. Yen A, Braverman IM (1976) Ultrastructure of the human dermal microcirculation: the horizontal plexus of the papillary dermis. J Invest Dermatol 66:131–142

    Article  CAS  PubMed  Google Scholar 

  37. Yu W, Li Y, Zheng YP, Lim NY, Lu MH, Fan J (2006) Softness measurements for open-cell foam materials and human soft tissue. Meas Sci Technol 17:1785–1791

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Biological Functions Engineering, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, 2-4 Hibikino, Wakamatsu-ku, Kitakyushu, 808-0196, Japan

    Hiroshi Yamada, Yoshiaki Inoue, Yuki Shimokawa & Keisuke Sakata

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  1. Hiroshi Yamada
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  2. Yoshiaki Inoue
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  3. Yuki Shimokawa
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  4. Keisuke Sakata
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Correspondence to Hiroshi Yamada.

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Yamada, H., Inoue, Y., Shimokawa, Y. et al. Skin stiffness determined from occlusion of a horizontally running microvessel in response to skin surface pressure: a finite element study of sacral pressure ulcers. Med Biol Eng Comput 55, 79–88 (2017). https://doi.org/10.1007/s11517-016-1500-2

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  • DOI: https://doi.org/10.1007/s11517-016-1500-2

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