What lies beneath: Why some pressure injuries may be unpreventable for individuals with spinal cord injury

Publication date: Available online 6 December 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): D.P. Lemmer, N. Alvarado, M.K. Henzel, M.A. Richmond, J. McDaniel, J. Graebert, K. Schwartz, J. Sun, K.M. Bogie

Abstract

Objective

To investigate intersections between pressure injury (PrI) history, muscle composition and tissue health responses under physiologically relevant loading conditions for individuals with spinal cord injury (SCI).

Design

Repeated measures study design with annual follow-up for up to 3 years.

Setting

Tertiary Care Center.

Participants

38 persons with SCI. Exclusion criteria included having an open pelvic region PrI at the time of recruitment, presence of systemic disease and/or known sensitivity to contrast.

Interventions

Not applicable.

Main Outcome Measure(s)

Gluteal muscle composition, ischial interface pressures, tissue oxygenation.

Results

Ischial region mean interface pressures are the same for individuals with or without a PrI history. Tissue oxygenation is lower during sitting for persons with a PrI history. Individuals with greater than 15% gluteal intramuscular fat were statistically highly significantly (p<0.001) more likely to have a history of severe or recurrent PrI. IMAT levels within the gluteal muscle may remain low over time or muscle tissue in the gluteal muscle region may be almost entirely replaced by IMAT. In the current study cohort, it was found that muscle composition also continues to change over time even for individuals with long-standing SCI

Conclusions

Soft tissue compositional changes, specifically increased gluteal intramuscular fat (IMAT), provides a reliable indicator of PrI history and may provide a key to personalized PrI risk status for persons with SCI. The current findings confirm that interface pressure mapping alone is a limited indicator for PrI development.

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