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Observational Study
. 2022 Dec;19(8):2191-2199.
doi: 10.1111/iwj.13829. Epub 2022 May 11.

Utilisation of skin blood flow as a precursor for pressure injury development in persons with acute spinal cord injury: A proof of concept

Yi-Ting Tzen  1   2   3 , Patricia T Champagne  1 , Varsha Rao  4   5 , Jijia Wang  1 , Wei-Han Tan  2   6 , Merrine Klakeel  2 , Nitin B Jain  2   3 , Dane K Wukich  3 , Timothy J Koh  7
Affiliations
Observational Study

Utilisation of skin blood flow as a precursor for pressure injury development in persons with acute spinal cord injury: A proof of concept

Yi-Ting Tzen et al. Int Wound J. 2022 Dec.

Abstract

People with spinal cord injury (SCI) are at high risk of developing a pressure injury. It is unclear why some people with SCI develop pressure injury while others with similar predisposing risk factors do not during acute hospitalisation. This may hinder healthcare utilisation to prevent pressure injuries. The purpose of the study was to examine the proof-of-concept objective bedside skin blood flow measurements before a pressure injury develops in spinal cord injured patients during acute hospitalisation. This was an observational study. All participants had acute traumatic SCI and were pressure injury-free upon enrollment. Skin blood flow patterns were collected at both heels under two circumstances: localised pressure for reactive hyperemia, and localised heating for heat hyperemia. Our results showed that reactive and heat hyperemia were successfully induced in all eleven participants. Two participants developed pressure injury and nine did not have pressure injury at discharge. Heat hyperemia was smaller in participants with pressure injury. No difference was observed in reactive hyperemia between the groups. In conclusion, skin blood flow measurements could be obtained at bedside during acute hospitalisation of SCI for the purpose of research. Further examination of a larger group is warranted to determine clinical use of heat hyperemia pattern as predictor for pressure injury development.

Keywords: hyperemia; microcirculation; pressure ulcer; spinal cord injuries.

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Conflict of interest statement

One author of this manuscript (Wukich) has the following conflict of interest that does not involve this manuscript: serves as a consultant with Orthofix Medical Inc., Stryker and Wright Medical, and receives royalties from Arthrex Inc.

Figures

FIGURE 1
FIGURE 1
Pressure indenter during (A) light touch, and (B) 60 mm Hg of pressure. (C) Heater probe with laser Doppler flowmetry needle probe in the center
FIGURE 2
FIGURE 2
Typical reactive hyperemia (top) and heat hyperemia (bottom) responses from the left heel of participant R5
FIGURE 3
FIGURE 3
(A) Boxplots of skin blood flow averaged every 5 seconds during reactive hyperemia at both heels. The ° represents outliers from participant R8. (B) Boxplots of skin blood flow averaged every 30 seconds during heat hyperemia at both heels. The ° represents outliers from participant A4 at 0.5 minutes, and R5 and R6 at 2 minutes. The * represents outliers from participant R6 at 5.5 and 7 minutes
See this image and copyright information in PMC

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