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The panniculus carnosus muscle: a missing link in the chronicity of heel pressure ulcers?

Authors
  • Nasir, N. Jannah M.
  • Corrias, Alberto
  • Heemskerk, Hans
  • Ang, Eng Tat
  • Jenkins, Julia H.
  • Sebastin, S. J.
  • Tucker-Kellogg, Lisa
Type
Published Article
Journal
Journal of The Royal Society Interface
Publisher
The Royal Society
Publication Date
Feb 23, 2022
Volume
19
Issue
187
Identifiers
DOI: 10.1098/rsif.2021.0631
PMID: 35193390
PMCID: PMC8864364
Source
PubMed Central
Keywords
Disciplines
  • Research Articles
License
Unknown

Abstract

Chronic and recurring pressure ulcers (PUs) create an unmet need for predictive biomarkers. In this work, we examine the panniculus carnosus, a thin cutaneous muscle, traditionally considered vestigial in humans, and ask whether the panniculus may play a role in the chronicity and reinjury of heel PUs. To determine whether humans have a panniculus muscle layer at the heel, we dissected eight cadavers. To assess the influence of the panniculus layer on PU, we performed computational simulations of supine weight bearing. Finally, we assessed panniculus regeneration in fluorescent mice. Results show a panniculus layer present in all cadavers examined. Simulations show a thin layer of panniculus muscle causes a dramatic decrease in the volume of soft tissue experiencing high strain and stress, compared to a heel without a panniculus. Importantly, in the mouse model, the panniculus fails to regenerate after PU, even when other cutaneous layers had fully regenerated. Our work shows that the panniculus is able to redistribute load around the heel bone, which might allow it to prevent PUs. Moreover, it is highly susceptible to incomplete regeneration after PU. Poor panniculus regeneration after PU might be a predictive anatomical biomarker for recurrence, and this biomarker should be evaluated prospectively in future clinical trials.

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