Abstract
BackgroundDeep tissue injury (DTI) is a class of serious lesions which develop in the deep tissue layers as a result of sustained tissue loading or pressure-induced ischemic injury. DTI lesions often do not become visible on the skin surface until the injury reaches an advanced stage, making their early detection a challenging task.TheoryEarly diagnosis leading to early treatment mitigates the progression of the lesion and remains one of the priorities in clinical care. The aim of the study is to relate changes in tissue temperature with key physiological changes occurring at the tissue level to develop criteria for the detection of incipient DTIs.MethodSkin surface temperature distributions of the damaged tissue were analyzed using a multilayer tissue model. Thermal response of the skin surface to a cooling stress, was computed for deep tissue inflammation and deep tissue ischemia, and then compared with computed skin temperature of healthy tissue.ResultsFor a deep lesion situated in muscle and fat layers, measurable skin temperature differences were observed within the first five minutes of thermal recovery period including temperature increases between 0.25°C to 0.9°C during inflammation and temperature decreases between −0.2°C to −0.5°C during ischemia.ConclusionsThe computational thermal models can explain previously published thermographic findings related to DTIs and pressure ulcers. It is concluded that infrared thermography can be used as an objective, non-invasive and quantitative means of early DTI diagnosis.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1461254346108378.
Highlights
Deep Tissue Injury (DTI) is a type of pressure injury that first arises in the deeper tissue with the overlying skin remaining intact
In the color coded temperature images a temperature increase is visible in the region of the lesion and its surroundings for inflammation, whereas the temperature decreases in this region for ischemia, when compared to healthy tissue
We modeled three multilayer cases: an 8 mm deep ischemic lesion surrounded by a 1.25 mm thick inflammation layer (Figure 11a); an 8 mm deep ischemic lesion surrounded by severe inflammation which extends up to the skin surface (Figure 11b) – a precursor of a pressure ulcer; and a 3.8 mm deep ischemic lesion that is surrounded by 1.25 mm thick inflammation layer (Figure 11c)
Summary
Deep Tissue Injury (DTI) is a type of pressure injury that first arises in the deeper tissue with the overlying skin remaining intact. Shea, who was credited for labeling the four stage system of pressure ulcers on the basis of the extent of soft tissue damage in 1975, described DTIs as innocent appearing lesions that are potentially fatal [3]. It was only in 2007 when this injury pattern was formally recognized by The National Pressure Ulcer Advisory Panel (NPUAP) [4]. The sequential progression of ischemia and inflammation and the associated temperature changes may not have been fully appreciated in these prior studies and this is one of the topics addressed in the present paper
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