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.
Highlights
Pressure ulcers (PUs) are painful wounds that are slow to heal, laborious to prevent and costly to manage
The panniculus carnosus layer is present in the human heel
The purpose of microdissections in cadavers was to examine the prevalence and distribution of the panniculus in the human heel; the purpose of the computational simulations was to understand the contribution of the panniculus layer to pressure redistribution and its biomechanical protection of the soft tissues near the bony prominence, and the purpose of the mouse regeneration studies was to assess whether regeneration of the panniculus is sufficient to continue protecting the soft tissue against pressure-induced reinjury
Summary
Pressure ulcers (PUs) are painful wounds that are slow to heal, laborious to prevent and costly to manage. In addition to slow healing, PUs have a high rate of recurrence at the same site (27–63%, depending on the study [8,9,10,11,12]), and efforts to predict PU recurrence have not yet been effective [13,14,15]. We ask whether a panniculus layer might play an underappreciated role in PU prevention, healing and recurrence. We ask whether the panniculus would protect the heel from PUs. we study panniculus regeneration after a PU, looking for any clues that could explain or predict the increased risk of PU recurrence or reinjury after an initial injury
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