Abstract
Objective:To follow up patients with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year.DesignA retrospective cohort study.SettingA Japanese rehabilitation center.ParticipantsWe included patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (n = 7).InterventionsEducation on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the patients were seated on the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system.Outcome MeasuresThe primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions.ResultsOf the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all patients, and the interface pressure could be reduced in 5/7 patients.ConclusionsThis is the first study to follow up with patients having spinal cord injuries and subdermal low-echoic lesions in the ischial region using ultrasonography. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in patients with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.
Highlights
A pressure injury (PI) is defined as localized damage to the skin and underlying soft tissue, usually over a bony prominence, and occurs due to intense or prolonged pressure or pressure in combination with shear forces [1]
We reported that in chronic spinal cord injuries (SCIs) patients who use wheelchairs daily, the areas with subdermal low-echoic lesions identified by ultrasonography were those with long pressure durations and high interface pressures [15]
The lowechoic lesions were located deeply adjacent to the bone and showed discontinuous fascia
Summary
A pressure injury (PI) is defined as localized damage to the skin and underlying soft tissue, usually over a bony prominence, and occurs due to intense or prolonged pressure or pressure in combination with shear forces [1]. There is an inverse relationship between pressure and time to tissue damage, and different types of tissues have different susceptibilities to ischemia [2–4]. Deeper tissues, such as the muscle, are reportedly more susceptible to pressure-related ischemia than the skin [5, 6]. DeLisa and Mikulic [7] reported that “the visible ulcer represents only the tip of the iceberg or the apex of the lesion” and pointed out that underlying soft tissue damage may occur even when the skin is visually intact. Kanno et al [11] have reported the benefits of early detection of skin abnormalities underneath by ultrasonography in patients with chronic spinal cord injuries (SCIs) by performing PI examination using combined inspection, palpation, and ultrasonography
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