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Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review.

Authors
  • Van Damme, Nele1
  • Van Hecke, Ann2
  • Remue, Eline2, 3
  • Van den Bussche, Karen1
  • Moore, Zena1, 4
  • Gefen, Amit5
  • Verhaeghe, Sofie2, 6
  • Beeckman, Dimitri1, 4, 7, 8, 9
  • 1 Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium. , (Belgium)
  • 2 University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium. , (Belgium)
  • 3 Nursing department, Ghent University Hospital, Ghent, Belgium. , (Belgium)
  • 4 School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland. , (Ireland)
  • 5 Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel. , (Israel)
  • 6 Department of Health Care, VIVES University of Applied Sciences, Roeselare, Belgium. , (Belgium)
  • 7 School of Health Sciences, Örebro University, Örebro, Sweden. , (Sweden)
  • 8 Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. , (Denmark)
  • 9 School of Nursing and Midwifery, Monash University, Melbourne, Australia. , (Australia)
Type
Published Article
Journal
Wound Repair and Regeneration
Publisher
Wiley (Blackwell Publishing)
Publication Date
Mar 01, 2020
Volume
28
Issue
2
Pages
242–265
Identifiers
DOI: 10.1111/wrr.12777
PMID: 31677314
Source
Medline
Language
English
License
Unknown

Abstract

Deep tissue injuries are pressure ulcers which initiate in the subcutaneous tissues and extend through a bottom-up pathway. Once deep tissue injuries are visual at skin level, serious irreversible tissue damage has already occurred. In pressure ulcer development, inflammation and edema are coupled physiological processes associated with tissue damage arising due to sustained mechanical loading. This study aimed to provide an in-depth overview of the physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues, in the context of pressure ulceration. A scoping review was performed according to the framework by Arksey and O'Malley. The databases MEDLINE, EMBASE, Web of Science, and Scopus, and the reference lists of included studies were searched for in vivo (animal, human), and in vitro studies matching the study objectives (from inception to 28 May 2018). No restrictions for inclusion were applied for study design, setting, participants, and year of publication. A total of 12 studies were included, varying in study design, sample characteristics, amount and duration of mechanical loads that were applied, follow-up time, and assessment methods. Neutrophil infiltration and edema occur in the subcutaneous tissues nearly immediately after the application of load on soft tissues. The amount of neutrophils and edema increase in the first days after the mechanical insult and decrease once healing has been initiated and no supplementary mechanical load was applied. One study indicated that edema may extend up to the level of the dermo-epidermal junction. Further research should focus on how deep tissue inflammation and edema are reflected into unique tissue changes at skin level, and how abnormal inflammatory responses manifest (e.g. when the nervous system is not functioning normally). © 2019 by the Wound Healing Society.

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