Abstract
Aim: The goals of this study were 1) to identify the relationship between adipose (subcutaneous and intramuscular) characteristics and pressure injury (PrI) history in wheelchair users and 2) to identify subject characteristics, including biomechanical risk, that are related to adipose characteristics. Materials and Methods: The buttocks of 43 full-time wheelchair users with and without a history of pelvic PrIs were scanned in a seated posture in a FONAR UPRIGHT® MRI. Intramuscular adipose (the relative difference in intensity between adipose and gluteus maximus) and the subcutaneous adipose characteristics (the relative difference in intensity between subcutaneous adipose under and surrounding the ischium) were compared to PrI history and subject characteristics. Results: Participants with a history of PrIs had different subcutaneous fat (subQF) characteristics than participants without a history of PrIs. Specifically, they had significantly darker adipose under the ischium than surrounding the ischium (subQF effect size = 0.21) than participants without a history of PrIs (subQF effect size = 0.58). On the other hand, only when individuals with complete fat infiltration (n = 7) were excluded did individuals with PrI history have more fat infiltration than those without a PrI history. The presence of spasms (μ intramuscular adipose, 95% CI with spasms 0.642 [0.430, 0.855], without spasms 0.168 [−0.116, 0.452], p = 0.01) and fewer years using a wheelchair were associated with leaner muscle (Pearson Corr = −0.442, p = 0.003). Conclusion: The results of the study suggest the hypothesis that changes in adipose tissue under the ischial tuberosity (presenting as darker SubQF) are associated with increased biomechanical risk for pressure injury. Further investigation of this hypothesis, and the role of intramuscular fat infiltration in PrI development, may help our understanding of PrI etiology. It may also lead to clinically useful diagnostic techniques that can identify changes in adipose and biomechanical risk to inform early preventative interventions.
Highlights
Full-time wheelchair users are at a higher risk for pressure injuries (PrIs) due to continuous, high magnitude loading and lack of sensation (Bergstrom et al, 1995; Salzberg, et al, 1996)
Because the changes in adipose are poorly understood, we investigated whether Intramuscular adipose tissue (IMAT) was associated with SubQF characteristics
Subcutaneous Adipose (SubQF) Tissue Since the adipose under the pelvis is the most susceptible area to PrIs, we evaluated the SubQF under the ischium and compared it with the segmented SubQF surrounding the ischium in the sagittal plane (Figure 3)
Summary
Full-time wheelchair users are at a higher risk for pressure injuries (PrIs) due to continuous, high magnitude loading and lack of sensation (Bergstrom et al, 1995; Salzberg, et al, 1996). Investigation into the role of adipose and its relationship to tissue tolerance and PrI risk has been limited, despite considerable evidence on the effect of adipose on an individual’s health (Garcia and Thomas 2006; Lemmer, Alvarado et al, 2019; Bogie, Schwartz et al, 2020). There are multiple kinds of adipose depots, such as visceral, intramuscular, and subcutaneous, that differ in adipose characteristics. Intramuscular adipose tissue (IMAT) is the sum of the fat that lies underneath the fascia and between muscle groups and the fat that is infiltrated between and/or within the muscle fibers. Subcutaneous fat (SubQF), by definition, exists deep to the epidermis and dermis and represents the majority of body fat
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