Deep Tissue Damage Research Articles

Primäre Rekonstruktion der ableitenden Tränenwege nach Trauma – bikanalikulonasale Schienung mit autostabilen Silikonverweilsonden

Trauma of the medial canthal region can affect all parts of the lacrimal ducts. Depending on the patient's age, there may be different mechanisms of injury. Surgical reconstruction using two autostable ("self-retaining") monocanaliculonasal lacrimal tubes is demonstrated by two case reports. Here, a 6 years old girl attacked by a dog (Rottweiler) showed severe periocular soft tissue damage with deep involvement of the lacrimal ducts. The child's inferior canaliculus was lacerated. Furthermore, the common canaliculus was dissected from the lacrimal sac. Deep soft tissue damage consisted of blunt and sharp injuries down to the cheek and nose. After lacrimal intubation with two autostable monocanaliculonasal tubes, the soft tissue was reconstructed by direct canalicular suturing and stepwise closure of each layer. One of the lacrimal tubes was fixated at the lid by additional sutures, in order to avoid stent prolapse. Beside slight medial depression of inferior lid, there were no signs of functional disturbance of the lacrimal ducts. The follow-up was 18 months. The second case report presents a 43 years old man. He accidentally cut himself with a butcher's knife. He suffered a deep wound of his medial canthal region. The patient presented with proximal (located near the lacrimal sac) laceration of both canaliculi. The medial canthal ligament as well as the orbicularis muscle had been cut. Using two autostable monocanaliculonasal lacrimal tubes, the lacrimal ducts were stented and reconstructed with sutures. During the follow-up of 6 months, no epiphora or mucopurulent lacrimal discharge occurred. In lacrimal trauma, different parts of the lacrimal ducts may be affected at the same time. Identification of the injured structures with respect to the kind of injury, localisation and the extent of damage is crucial. Stepwise wound closure in respect to the topographic anatomy is mandatory. Here, lid and lacrimal ducts must be respected as one functional unit. Simultaneous use of autostable monocanaliculonasal lacrimal tubes in both canaliculi can be applied for trauma reconstruction of the lacrimal ducts in children and adults.

14,000 Volt Electrical Injury to Bilateral Upper Extremities: A Case Report

Electrical burns are among the most devastating of burn injuries. High voltage electrical injuries result in extensive deep tissue damage and are associated with multiple complications, long term morbidity, and a high mortality rate. We describe the case of a 47 year-old electric company linesman who suffered a high voltage electrical injury (HVEI) of 14,000 volts to bilateral hands and wrists managed by the Division of Plastic and Reconstructive Surgery at the McGill University Health Center in Montreal, Quebec, Canada. His management included multiple operative procedures, including escharotomies, fasciotomies, serial debridements, and bilateral pedicle groin flaps, and amputation of his left hand.

The relationship between skin ultrasound images and muscle damage using skin blotting in wheelchair basketball athletes.

Secondary analysis of a cross-sectional observation study. To determine the relationship between skin ultrasound images and muscle damage in wheelchair basketball athletes, using skin blotting examinations of the ischial regions. Community, Japan. Fourteen elite wheelchair basketball athletes were recruited. We obtained data regarding participants' characteristics. We undertook ultrasonographic images and quantitative skin blotting of the ischial region before and after training, and after rest. We identified Category II and III pressure injuries in 2 of the 12 participants. Structural features were classified into four categories based on ultrasonographic features, namely, normal skin structure, unclear superficial and deep fascia, cloudy fat layer, and fat infiltration and low-echoic lesion/anechoic lesions. The muscle-type creatinine kinase (CK-M) level (median [interquartile range: IQR], 2.98 [2.80-3.47]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.43 [1.41-1.49]) than in a nonfat infiltration and low-echoic lesion/anechoic lesion group after training (p = 0.03). The interleukin-6 (IL-6) level (median [IQR], 23.5 [16.15-58.97]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.94 [1.74-4.44]) than in the nonfat infiltration and low-echoic lesion/anechoic lesion group after rest (mean difference = -25.4, 95% CI -61.1 to 10.7, p = 0.03). The combination of ultrasonographic images and skin blotting using CK-M and IL-6, could detect early deep tissue damage in wheelchair athletes. These techniques could be potentially useful in the treatment and prevention of pressure injuries. This study was supported in part by YAMAHA Motor Foundation for Sports.

Real-time and noninvasive detection of UV-Induced deep tissue damage using electrical tattoos

Understanding longterm deep tissue damage caused by UV radiation is imperative for ensuring the health and safety of living organisms that are regularly exposed to radiation sources. While existing UV dosimeters can quantify the cumulative amount of radiation to which an organism is exposed, these sensors cannot reveal the presence and extent of internal tissue damage caused by such exposure. Here we describe a method that uses conducting polymer tattoos to detect UV radiation-induced deep tissue damage in living organisms using bioimpedance analysis (BIA), which allows for noninvasive, real-time measurements of body composition and point-of-care assessment of clinical condition. To establish a performance baseline for this method, we quantify the effects of UVA radiation on live plant leaves. Low-energy UVA waves penetrate further into biological tissue, as compared to UVB, UVC and ionizing radiation, and cause longlasting deep tissue damage that cannot be immediately and readily detected using surface-sensitive techniques, such as photogrammetry and epidermal sensors. We show that single-frequency bioimpedance analysis allows for sensitive, real-time monitoring of UVA damage: as UVA dose increases, the bioimpedance of a plant leaf measured at a frequency of 1 kHz linearly decreases until the extent of radiation damage saturates and the specimen is effectively necrotized. We establish a strong correlation between radiation fluence, internal biological damage and the bioimpedance signal measured using our conducting polymer tattoos, which supports the efficacy of our method as a new type of internal biodosimetry.

Sodium pyruvate pre-treatment prevents cell death due to localised, damaging mechanical strains in the context of pressure ulcers.

We demonstrate sodium pyruvate (NaPy) pre-treatment as a successful approach for pressure ulcer (PU) prevention by averting their aetiological origin-cell-level damage and death by large, sustained mechanical loads. We evaluated the NaPy pre-treatment effect on permeability changes in the cell's plasma membrane (PM) following application of in vitro damaging-level strains. Fibroblasts or myoblasts, respectively, models for superficial or deep-tissue damage were grown in 0 or 1 mM NaPy, emulating typical physiological or cell culture conditions. Cells were pre-treated for 4 hours with 0 to 5 mM NaPy prior to 3-hour sustained, damaging-level loads (12% strain). PM permeability was quantified by the cell uptake of small (4 kDa), fluorescent dextran compared with unstrained control using fluorescence-activated cell sorting (FACS). Pre-treatment with 1 mM, and especially 5 mM, NaPy significantly reduces damage to PM integrity. Long-term NaPy pre-exposure can improve protective treatment, affecting fibroblasts and myoblasts differently. Pre-treating with NaPy, a natural cell metabolite, allows cells under damaging-level mechanical loads to maintain their PM integrity, that is, to avoid loss of homeostasis and inevitable, eventual cell death, by preventing initial, microscale stages of PU formation. This pre-treatment may be applied prior to planned periods of immobility, for example, planned surgery or transport, to prolong safe time in a position by preventing initial cell damage that can cascade and lead to PU formation.

Sham surgeries for central and peripheral neural injuries persistently enhance pain-avoidance behavior as revealed by an operant conflict test.

Studies using rodent models of neuropathic pain use sham surgery control procedures that cause deep tissue damage. Sham surgeries would thus be expected to induce potentially long-lasting postsurgical pain, but little evidence for such pain has been reported. Operant tests of voluntary behavior can reveal negative motivational and cognitive aspects of pain that may provide sensitive tools for detecting pain-related alterations. In a previously described operant mechanical conflict test involving lengthy familiarization and training, rodents freely choose to either escape from a brightly lit chamber by crossing sharp probes or refuse to cross. Here, we describe a brief (2-day) mechanical conflict protocol that exploits rats' innate exploratory response to a novel environment to detect persistently enhanced pain-avoidance behavior after sham surgeries for 2 neural injury models: thoracic spinal cord injury and chronic constriction injury of the sciatic nerve. Pitting the combined motivations to avoid the bright light and to explore the novel device against pain from crossing noxious probes disclosed a conflicting, hyperalgesia-related reluctance to repeatedly cross the probes after injury. Rats receiving standard sham surgeries demonstrated enhanced pain-like avoidance behavior compared with naive controls, and this behavior was similar to that of corresponding chronic constriction injury or spinal cord injury rats weeks or months after injury. In the case of sham surgery for spinal cord injury, video analysis of voluntary exploratory behavior directed at the probes revealed enhanced forepaw withdrawal responses. These findings have important implications for preclinical investigations into behavioral alterations and physiological mechanisms associated with postsurgical and neuropathic pain.

ANALYSIS OF MEDICAL RESCUE OPERATIONS PERFORMED BY MEDICAL RESCUE TEAMS FROM ALL OVER POLAND IN PATIENTS WITH BURN WOUNDS

Introduction: A burn is a superficial or deep tissue damage caused by the action of: heat (high temperature), chemicals, electric current, solar rays and ionizing radiation. The aim: To analyze the trips of emergency medical teams in the period from November 1, 2017 to April 30, 2018 to patients diagnosed with burns throughout the country. Materials and methods: The analysis covers the whole of Poland, all medical rescue teams. The obtained data comes from the System of Supporting the State Medical Rescue System. The analysis includes the characteristics of the population studied and the medicines used. The study included those that ended with the diagnosis of burns (T-20 to T-32). Taking into account the above criteria, 547 cases were obtained. Results: In 321 cases, there were women and 226 cases of men (58.68% vs 41.32%, p<0.001). More often, it referred to patients over 18 (317 cases vs. 193 below 18 years of age, p<0.001) in 37 cases no data. Most events were recorded in the Masovian and Silesian voivodships (12.97% and 11.33%) and the least in Podlasin (2.92%). In 20.47% of cases, pain treatment was applied, of which in the group of adults in 25.23% vs. 1658% in children, p<0.001. Conclusions: The above results of medical emergency teams' activities indicate insufficient pharmacological treatment, which requires rapid improvement.

Nonthermal atmospheric plasma enhances myoblast differentiation by eliciting STAT3 phosphorylation.

The use of nonthermal atmospheric plasma (NTP) in the biomedical field has recently expanded into cell death induction in cancer, infection prevention, inflammation treatment, and wound-healing enhancement. NTP has been demonstrated to enhance skin and muscle regeneration, but its effects on tissue regeneration, following deep tissue or muscle damage, remains underinvestigated. In this study, we determined the effects of NTP on muscle differentiation and the mechanisms of NTP's contribution to differentiation and regeneration. NTP treatment enhanced cell differentiation in primary normal human skeletal muscle myoblast cells and increased the relative expression of mRNA levels of MyoD which is one of the earliest markers of myogenic commitment, and myogenin, which are important transcription factors required for myogenic differentiation. Furthermore, NTP treatment induced increases in the levels of myosin heavy chain, a differentiated muscle-specific protein, and in myotube formation of myoblasts. We observed that signal transducer and activator of transcription 3 (STAT3) activation induced by NTP treatment affects the myogenic differentiation. In addition, STAT3 phosphorylation was also enhanced by NTP treatment in injured animal muscle. These findings indicate that NTP could enhance musculoskeletal differentiation by acting as an external stimulus for myoblast differentiation, suggesting its treatment potential in promoting regeneration of damaged muscle.-Park, J. K., Kim, Y. S., Kang, S. U., Lee, Y. S., Won, H.-R., Kim, C.-H. Nonthermal atmospheric plasma enhances myoblast differentiation by eliciting STAT3 phosphorylation.

Recognition and correct classification of pressure ulcers: aposition paper

Pressure ulcers comprise serious skin and tissue damage. The correct diagnosis and classification into different categories is often difficult in daily practice. What procedure can be recommended to correctly diagnose and classify pressure ulcers in practice? The society Initiative Chronische Wunden (ICW) e. V. established agroup of experts who developed practical recommendations for the diagnosis and classification of pressure ulcers based on the current literature and their own expertise. Pressure ulcers should only be diagnosed if skin and/or tissue damage is most likely due to prolonged pressure or pressure associated with shear forces. Acomplete anamnesis must be performed to detect periods of previous prolonged immobility. Pressure ulcers are usually located at typical predilection sites. For categoryI and "suspected deep tissue damage" the tissue damage occurs under (initially) intact skin. However, the diagnosis is uncertain and the classification should be made later. The categoryII pressure ulcer is usually an exclusion diagnosis. The categoriesIII andIV are pressure ulcers in the proper sense. As long as the distinction between categoryIII andIV is not possible, the lower category should be coded. Currently, arelevant classification should be used uniformly for the respective setting. In accordance with the clinical picture, amost suitable diagnosis is to be made. It does not matter which classification system is used. The future WHO ICD-11 version will allow better classification of pressure ulcers.

Autolytic and Conservative Sharp Wound Debridement for Granulation Tissue on Unstageable Diabetic Foot Ulcer

Diabetic foot ulcer (DFU) is a condition of deep tissue damage associated with Diabetes Mellitus in the lower extremities. Conducted with quantitative research of single group method with pre and post test design approach, this research primarily aims to know the effectiveness of utilizing combination of Autolysis &amp; Conservative Sharp Wound Debridement in preparing granulation on unstageable DFU. It involved 30 respondents in the wound care clinic as the research sample and used the Wound Bed Score observation sheets measured on days 1, 7 and 28. The data analysis to determine effectiveness before and after intervention was carried out using dependent t-test (paired t-test), whilst to test effectiveness of giving intervention after controlled confounder was performed by linear regression. Based on the characteristics of the respondent’s, it is revealed that most of them were female (83.3%)&#x0D; and have normal BMI (80%). The average age of the respondents were 55.43 years old with the duration of DM of 13.27 years with average blood sugar of 101.2 mg/dL. The highest mean difference was on the 1st day of the 28th. The statistical results of this study indicated that the mean difference values for day 1 and 7 were 0.133 (SD 1.19, p value = 0.546), mean difference of day 7 and day 28th grade was of 2.5 (SD 1.306, p value=0.0001) and mean difference between day 1 and day 28 was of 2.63 (SD 1.273, p value=0.0001). This research recommends that the further research use different research methods.

The aetiology of deep tissue injury: a literature review.

Deep tissue injury affects patients of all ages in a variety of healthcare settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in order to accurately assess the pressure ulcer risk of vulnerable patients, and to subsequently reduce patient harm. The majority of pressure ulcers are avoidable, however, a variety of intrinsic and extrinsic factors can contribute towards the development of deep tissue injury. Understanding the body's internal responses to external pressure will enable nurses to recognise that a visual assessment alone may not necessarily identify patients at risk of deep tissue damage. This article reviews the evidence for the internal causative mechanisms of deep tissue injury, while linking to clinical practice and pressure ulcer prevention.

Nursing knowledge and behaviors of main caregivers for stroke patients with outside-hospital pressure ulcer

Objective To explore the present situation of pressure ulcer of outside-hospital stroke patients, and to investigate caring knowledge and behaviors of their caregivers on pressure ulcer prevention and treatment. Methods From January to November in 2014, questionnaire was conducted in 78 caregivers of stroke patients with outside-hospital pressure ulcer. Results Within two hours after admission, 85.9% of patients were graded as high risk by Braden scale, while 79.2% belonged to grades I and Ⅱ. 15.0% of the patients were hard to be graded or suspected to be with deep tissue damage. In the caregiver′s pressure ulcer prevention and treatment questionnaire, the relatively higher score went to skin care, while the lowest went to knowledge of pressure ulcer prevention, followed by the coping methods after occurrence of pressure ulcers. For dimensions of caring behavior in the questionnaire, the dimension of skin care acquired the highest score, while turning-over was the lowest, followed by wound care. Conclusions For community stroke patients, present situation of skin care is not satisfactory, and prevention knowledge and caring behavior of their caregivers on pressure ulcer need to be strengthened. Key words: Stroke; Pressure ulcer; Caregiver; Caring behavior; Knowledge of prevention and treatment

Repair of skin and soft tissue defects around the knee joints

Skin and soft tissue defects around the knee joints are often accompanied by popliteal artery injury, patellar ligament injury, patellar fracture, and other deep tissue damage or exposure, making them challenging to repair. The principle is to repair the wound, reconstruct anatomical structure of the knee joint, and recover the knee joint function. At present the reconstruction with skin flap or myocutaneous flap is our priority. Local flap or myocutaneous flap can be used for repairing minor defects around the knee joints. Repairing with perforator flap, fascia flap, and free flap are main alternatives for covering larger and complex defects around the knee joints. During the treatment, a joint effort is mandatory, not only to repair the wound, but also to reconstruct vasculature, fix fracture, repair ligament, and finally recover the knee joint function. Therefore, the importance of multidisciplinary cooperation must be emphasized. Moreover, along with the development of new technologies, new methods, and new materials, perforator flap plays an important role in repairing skin and soft tissue defects around the knee joints.

Vibration inhibits deterioration in rat deep-tissue injury through HIF1-MMP axis.

Deep-tissue injury (DTI) is a unique type of pressure ulcer (PU) in which deep-tissue damage expands outwards to the superficial skin. DTI progresses rapidly into a severe PU, despite initially appearing as only a bruise or darkened tissue in the superficial skin. Although some DTI detection methods are available, there is currently no strategy for treating deteriorating DTI. This study investigated the efficacy of vibration therapy for preventing DTI deterioration through down-regulation of the hypoxia-inducible factor-1 matrix metalloproteinase (MMP) axis in rats. We prepared a conventional PU rat model (PU group) and a DTI deterioration rat model (DTI group). The DTI group was further divided into two groups subjected to vibration and control treatments, respectively. Macroscopic and histological features, hypoxia, oxidative stress, apoptosis, and MMP2 and MMP9 activities in compressed skin were analyzed. Hypoxia, oxidative stress, and MMP activity were enhanced in the DTI group compared with the PU group. Vibration remarkably inhibited DTI deterioration, hypoxia, and the expression/activities of MMP2 and MMP9. These results suggest that vibration therapy can effectively attenuate deterioration of DTI. This report provides the first evidence for a therapeutic treatment for deteriorating DTI.

Electrical injuries of the oral cavity: A menace to mankind

The rarest of its kind, the electrical injuries of the commissure areas of the mouth pose a potential threat in terms of management to the practitioner. The most commonly affected young toddlers, in their teething period, chew onto the female end of the live extension wire cord. Saliva which acts a medium transports the electrical current to the fragile mucosa of the oral cavity thereby leading to the treacherous burn injuries. Since children have an overall lower fat component and different surface area to volume ratio, which impacts on the risk of deep tissue damage compared to adults with equivalent injury. The review outlines: (1) A detailed review of literature reflecting the various treatment modalities proposed by different practitioners worldwide and (2) the prosthetic therapy for the conservative management of the electrical injuries of the oral cavity.

Establishment of a novel rat model for deep tissue injury deterioration

Deep tissue injuries (DTIs) can become significant problems because of their rapid deterioration into deep pressure ulcers. Presently, no animal model of DTI deterioration has been developed. By concentrating pressure and shear stress in deep tissues while minimising pressure and shear stress in the overlying skin, we produced an effective rat model of DTI deterioration. Two-dimensional finite element method (FEM) simulated the distribution of pressure and shear stress under several pressure-loading conditions. FEM showed that concentrated shear stress in deep tissue with minimum shear stress in the overlying skin could be created by using a prominence and a cushion, respectively. On the basis of the results of FEM analysis, we selected suitable conditions for testing the rat DTI deterioration model. The compressed area was macroscopically observed until day 13, and histopathologic analysis via haematoxylin and eosin (H&E) staining was performed on days 3, 7 and 13. H&E staining showed that the distribution of tissue damage was similar to the predicted FEM results. Deep ulceration and tissue damage extending from deep tissues to the overlying skin and surrounding tissues were observed in the DTI deterioration model, which are similar to the clinical manifestations of DTI deterioration. In conclusion, a representative DTI deterioration model was established by concentrating high shear stress in deep tissues while minimising shear stress in the overlying skin. This model will allow a better understanding of the mechanisms behind DTI deterioration and the development of preventative strategies.

Collateral Tissue Damage by Several Types of Coagulation (Monopolar, Bipolar, Cold Plasma and Ultrasonic) in a Minimally Invasive, Perfused Liver Model

Hemostasis in minimally invasive surgery causes tissue damage. Regardless of the method of production of thermal energy, a quick and safe coagulation is essential for its clinical use. In this study we examined the tissue damage in the isolated perfused pig liver using monopolar, bipolar, cold plasma, and ultrasonic coagulation. In a minimally invasive in vitro setup, a 2-3 cm slice of the edge of the perfused pig liver was resected. After hemostasis was achieved, liver tissue of the coagulated area was given to histopathological examination. The depth of tissue necrosis, the height of tissue loss, and the time until sufficient hemostasis was reached were analyzed. The lowest risk for extensive tissue damage could be shown for the bipolar technique, combined with the highest efficiency in hemostasis. Using cold plasma, coagulation time was longer with a deeper tissue damage. Monopolar technique showed the worst results with the highest tissue damage and a long coagulation time. Ultrasonic coagulation was not useful for coagulation of large bleeding areas. In summary, bipolar technique led to less tissue damage and best coagulation results in our minimally invasive model. These results could be important to recommend bipolar coagulation for clinical use in minimally invasive surgery.

Candidate biomarkers for deep tissue damage from molecular biological and biochemical aspects

Suspected deep tissue injury (DTI) is a new category of pressure ulcer (PU), and defined as an ulcer that developed from a deep tissue (subcutaneous tissue) region and deteriorates towards the superficial skin. DTI is a serious clinical problem because it cannot be detected at an early stage and rapidly deteriorates to a deep PU. Consequently, there is a requirement for the identification of novel biomarkers to detect damage to the deep tissue including deep muscle tissue. For this purpose, it is essential to understand the molecular and cellular mechanisms of DTI formation and deterioration. This article reviews the recent progress in studies on the hypoxia-related mechanisms of DTI, and introduces our attempts to establish novel biomarkers for detecting deep muscle damage. Hypoxia-inducible factor 1 α subunit (HIF1-α) is a widely used marker for hypoxic conditions. We detected increased expression and localization of HIF1-α in the deep muscle tissue of PU model rats, indicating that HIF1α is a key molecule in DTI and a valuable biomarker for hypoxia in DTI in the research field. From the biochemical aspect, we focused on creatine phosphokinase (CPK). CPK is an intracellular enzyme related to energy metabolism, and its level in serum has been extensively used as a diagnostic marker for muscle injury. We attempted to estimate muscle injury from the CPK levels in exudates, which can be collected non-invasively and reflect the microenvironmental conditions. Our results using PU model rats suggested that exudate CPK could be a more sensitive biomarker than serum CPK for deep muscle tissue injury, and could be applicable for clinical diagnosis of DTI.

Not another 4th of July report: uncommon blast injuries to the hand

Objectives:Blast injuries to the hand are rare during peacetime and are mainly caused by fireworks. The injury patterns combine a variety of tissue destruction (laceration, dissemination, avulsion, blast, crush and...

Internal thermal injury: A case report

Internal burns resulting from thermal injury are not well documented in the literature. Thermal burns are categorized as first, second, and third degree based on depth, however, those burns that extend into deeper tissues have not had such a clear classification. Fourth degree burns are defined as injury extending to the subcutaneous fat, muscle, or bone. Although cutaneous second and third degree burns can be mapped to yield a percentage burn, this does not adequately describe the deeper tissue damage in a given burn patient. There have been very few reports of diffuse deep tissue burns resulting from thermal injury. We will refer to this as internal thermal injury. A 47-year-old male fire fighter was involved in a training exercise and was found unresponsive. This patient had been in the basement of a facility specially designed for fire fighter training exercises where he was found unconscious with an estimated exposure time of 8 min. The patient expired in cardiac arrest within 24 h of presentation. The physiological impact of high ambient temperatures on fire fighters has been well documented in the literature. Internal thermal injury was suspected given the history. Values assessed in training buildings, such as the one in which the patient was found, showed temperatures of 50-130 degrees C on the ground and 100-190 degrees C at 1 m above the ground. Temperatures of over 278 degrees C had been recorded within training buildings. Pain threshold is reached at a skin temperature of approximately 44 degrees C, and burn injury can occur at lower temperatures, depending on time of contact. Skin temperatures of fire fighters were found to range from 39 to 45.5 degrees C and core temperatures were measured by a miniature sensor in the form of a pill and were found to rise by 0.6-1 degrees C in 1 h within a training building. Therefore, it is possible that fire fighters undergo internal thermal injury before the sensation of cutaneous burn injury may be perceived. Kevlar is a material found in fire fighting gear and has been documented to have a degradation temperature of 520 degrees C. Kevlar can withstand high environmental temperatures; however, a great number of thermal injuries are due to an overheating of the body regardless of the thermal properties of Kevlar.