Pressure Ulcer Formation Research Articles

A Mathematical Model of Pressure Ulcer Formation to Facilitate Prevention and Management.

Pressure ulcers are a frequent issue involving localized damage to the skin and underlying tissues, commonly arising from prolonged hospitalization and immobilization. This paper introduces a mathematical model designed to elucidate the mechanics behind pressure ulcer formation, aiming to predict its occurrence and assist in its prevention. Utilizing differential geometry and elasticity theory, the model represents human skin and simulates its deformation under pressure. Additionally, a system of ordinary differential equations is employed to predict the outcomes of these deformations, estimating the cellular death rate in skin tissues and underlying layers. The model also incorporates changes in blood flow resulting from alterations in skin geometry. This comprehensive approach provides new insights into the optimal bed surfaces required to prevent pressure ulcers and offers a general predictive method to aid healthcare personnel in making informed decisions for at-risk patients. Compared to existing models in the literature, our model delivers a more thorough prediction method that aligns well with current data. It can forecast the time required for an immobilized individual to develop an ulcer in various body parts, considering different initial health conditions and treatment strategies.

Nanotechnological Antibacterial and Conductive Wound Dressings for Pressure Ulcer Prevention.

The development of pressure ulcers, associated with increased temperature and moisture in specific areas of the body, and the risk of microbial infections in patients lying in a static position for prolonged periods of time represents a serious issue in medicine. In order to prevent the formation of pressure ulcers, this work aims to present advanced nanostructured coatings developed by three research groups. Nanometric silver, ash and functionalized torrefied biomass were the basis for the treatment of wound dressings to improve thermal conductivity and antimicrobial properties of the conventional cotton gauzes. Each treatment was performed according to its own optimized method. The treated fabrics were characterized in terms of antimicrobial properties, heat transfer, morphology and hydrophobic behavior. The results demonstrated the effectiveness of the deposition treatments also in synergistic actions. In particular, the antibacterial efficacy was improved in all the samples by the addition of silver treatment, and the thermal conductivity was enhanced by around 58% with nanometric ashes. A further step of the study involved the designing of two multilayer systems evaluated using circuit models for determining the total thermal conductivity. In this way, both systems were designed with the aim to guarantee simultaneous efficacy: high antibacterial and hydrophilic properties at the skin level and more hydrophobic and conductive behaviors toward the external environment.

Exposure to volatile ferroptosis inhibitor, TEMPO, reduced cutaneous ischemia-reperfusion injury progression to pressure ulcer formation in a mouse model

BackgroundIschemia– reperfusion (I/R) injury-induced oxidative stress is a key factor in the pathogenesis of pressure ulcer formation. Ferroptosis is an iron-dependent programmed cell death that connects oxidative stress and inflammation in various diseases. Recent studies revealed the protective effect of inhibition of ferroptosis in I/R injury. However, the role of ferroptosis in cutaneous I/R injury remains elusive. ObjectiveTo assess the role of ferroptosis in the progression of cutaneous I/R injury. MethodsCutaneous I/R injury experiments and histopathological studies were performed in wild-type mice with or without exposure to volatile ferroptosis inhibitor, TEMPO (2,2,6,6-Tetramethylpiperidine-1-oxyl). The suppressive effects of TEMPO on ferroptosis inducing cell death and oxidative stress were examined in vitro. ResultsInhibition of ferroptosis with TEMPO significantly reduced ulcer formation after cutaneous I/R injury. Fluctuated ferroptosis markers, such as GPX4, ACSL4, and 4-HNE expression in the I/R skin site, were reversed by TEMPO treatment. Inhibition of ferroptosis reduced apoptosis, CD3+ infiltrating lymphocytes, and improved vascularity in the I/R skin site. Inhibition of ferroptosis also suppressed the enhancement of Nrf2 activation. In vitro, ferroptosis and the activation of ferroptosis-related gene expression by RSL3 stimulation were markedly ameliorated by TEMPO treatment in mouse fibroblasts. Inhibiting ferroptosis also suppressed the elevation of the mRNA levels of NOX2 and HO-1 caused by ferroptosis. ConclusionCutaneous I/R injury-induced ferroptosis likely promotes cell death, vascular loss, infiltration of inflammatory cells, and oxidative stress. The inhibition of ferroptosis with TEMPO might have potential clinical application as novel therapeutic agent for cutaneous I/R injury.

Effect of comprehensive nursing intervention on the formation of pressure sore in patients undergoing orthopaedic surgery in prone position.

Pressure ulcers are a common complication of prone orthopaedic surgery, causing pain and inconvenience to patients. This study aimed to evaluate a comprehensive nursing intervention for pressure ulcer formation in these patients. A total of 120 patients undergoing prone orthopaedic surgery were randomly divided into two groups. The study group (60 patients) received a comprehensive nursing intervention, whereas the control group (60 patients) received a routine nursing intervention. After 2 weeks, the comprehensive nursing intervention significantly reduced the incidence and degree of pressure sores and led to a shorter recovery time than the routine nursing intervention (p < 0.05). The incidence of postoperative wound complications was decreased, and patient satisfaction was significantly improved (p < 0.05). The Hamilton Anxiety Scale, Hamilton Depression Scale and visual analogue scale scores of the study group were significantly lower than those of the control group, and the Short Form 36 Health Survey Questionnaire scores were higher than those of the control group (p < 0.05). A comprehensive nursing intervention can significantly reduce the incidence and degree of pressure ulcers, accelerate recovery time, reduce postoperative wound complications and improve the quality of life and satisfaction of patients undergoing prone orthopaedic surgery.

Reconstructive Options for Pressure Ulcers in Pediatric Patients.

Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up. This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps. Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory. Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence.

Statistical and cross-sectional analysis of factors effecting the prevalence of pressure ulcer in hospital admitted stroke patients

Every year, millions of people around the world are disabled by stroke, it is well recognized that complications aftera stroke extend hospital stays and pressure ulcers, a stroke consequence, which can be prevented by educating the caregiver. The primary focus of this research is not only to investigate the prevalence of pressure ulcers (PU) among stroke patients, but this study also introduced a variety of factors which influence the formation of PU, such as restricted mobility, gender, duration of stroke, hypertension, diabetes, hygiene, type of mattress, malnutrition, awareness, etc. In addition, this research provides a comparative and statistical analysis, a cause of the catastrophic disabilities influenced by a variety of factors. Moreover, the proposed research also provides a room for the pertinent treatment of stroke patient to curtail the formation of pressure ulcer. In this research, a total of 120 stroke patients were initially included to monitor the frequency of pressure ulcers at incipient stage. Out of the total patients, the number of patients with ischemic stroke were 78.5 % while 8.3 % were of haemorrhagic type. In the results, the demographic characteristics and the factors which influence the formation of PU of the patients were examined with their cross-sectional impact on each other through comparative and statistical analysis. It was discovered that among all the stroke patients, 8.3 % were found with a PUs and the most frequent localization was sacrum and no new PU was observed for the participants under the observation.

A clinical study of surgical management of pelvic girdle pressure sores: a three-year experience

Introduction It is critical to categorize pressure ulcers at different stages to establish effective treatment plans. Debridement and excision of the underlying bursa and implicated bone tissue, followed by tissue covering, are the basic surgical procedures. This research examines patient characteristics, results, and complications, reporting on our experience treating pressure ulcers. Methods All the 25 individuals had a total of 39 pressure ulcers treated. The sacral ulcer was the most common. Three-quarters of the cases were related to pressure ulcer formation in hospitals. Debridement, primary repair, skin grafts, V-Y fasciocutaneous flap, transverse lumbar fasciocutaneous flap, V-Y tensor fascia lata flap, inferior gluteal rotational myocutaneous flap, and V-Y gluteal myocutaneous flap were among the available treatment options. Results Complications happened in 19%. Most of the time, pressure ulcers may be prevented with adequate understanding of their etiology and appropriate patient treatment for those who are at risk. Given the frequency of complications, recurrence, and new ulcers, treatment of individuals with pressure ulcers requires multidisciplinary involvement as well as family involvement. For the best prognosis and appropriate closure of the ulcer, complications and risk factors such as poor hygiene, anemia, diabetes, infection, and hypoalbuminemia should be avoided. Conclusion In the medical sector as a whole, pressure sores are a prevalent issue. The pelvic girdle pressure points appear to be the focus of most sores. Medical personnel who are in charge of patient monitoring must be knowledgeable about the main risk factors.

Comparison of Waterlow and Braden scores for predicting pressure ulcer development in intensive care unit patients: A prospective observational cohort study

Abstract Background and Objectives: Intensive care unit (ICU) patients are highly vulnerable to the development of pressure ulcers (PUs). Risk score scale that would efficiently predict the formation of PU in such patients includes the Waterlow Scale and the Braden Scale. Our objective was to determine the cutoff values of these scores for predicting PU formation in the ICU. Materials and Methods: A prospective observational study was conducted in the ICU of tertiary care center with 74 admitted patients. Inclusion criteria were Braden score ≤18 and Waterlow score &gt;15 at admission to ICU and without preexistent ulcer. Assessment was done at 24-h intervals, after admission using Braden and Waterlow Scales till the patient reached a predefined endpoint development of PU, discharge, or transfer from ICU or death. Results: Thirty-nine patients developed PUs during their ICU stay. Waterlow score on the penultimate day for those who developed ulcers had a lower coefficient of variance (13.30) and greater area under receiver operating characteristic (0.977) than that of Braden (14.20; 0.888). A Waterlow score &gt;20 (sensitivity 97.4%, specificity 88%, and accuracy 93.75%) and Braden score of &lt;12 (sensitivity 97.4%, specificity 60%, and accuracy 82.81%) were predictors of impending ulcer formation in ICU patients. Conclusion: A Waterlow score &gt;20 (19.5) may be taken as a cutoff for predicting impending ulcer formation for ICU patients. Whenever Braden scores are used instead of Waterlow, a cutoff of &lt;12 (12.5) is indicative of higher chances of ulceration.

Challenges and adverse events in pediatric hypoglossal nerve stimulation

IntroductionHypoglossal nerve stimulation was recently FDA approved for use in children with Down Syndrome and persistent obstructive sleep apnea. Although there is a robust experience in hypoglossal nerve stimulation in adults, we observed several challenges that are unique to providing this therapy to a complex pediatric population with a high rate of sensory processing disorders. We sought to review the adverse events and challenges to inform clinicians as hypoglossal nerve stimulation becomes a more accessible option for this complex population. MethodsRetrospective case series of children with Down Syndrome and persistent OSA who underwent hypoglossal nerve stimulation. Inclusion and exclusion criteria included Down Syndrome, age 10–22 years, persistent severe OSA after adenotonsillectomy (AHI>10 with <25 % central or mixed events), inability to tolerate positive airway pressure, and absence of concentric palatal collapse on sleep endoscopy. Patients were identified and their charts were reviewed. Adverse events and their subsequent management were recorded. The major outcome variable was the total number of adverse events. ResultsA total of 53 patients underwent implantation of a hypoglossal nerve stimulator; 35 (66 %) patients were male and the average age at implantation was 15.1 years (standard deviation 3.0y). A total of 30 adverse events were noted, including 17 nonserious and 13 serious. The most common nonserious complications included temporary tongue discomfort, rash at the surgical site, and cellulitis. Serious complications included readmission (for cellulitis, pain, and device extrusion), reoperation (most commonly for battery depletion) and pressure ulcer formation. ConclusionHypoglossal nerve stimulation provides a much-needed therapy for children with DS and persistent OSA after adenotonsillectomy. Although there is a robust experience in providing this treatment to adults, many considerations must be made when adapting this technology to a pediatric population with a high rate of sensory processing disorders.

Extracellular vesicle-derived silk fibroin nanoparticles loaded with MFGE8 accelerate skin ulcer healing by targeting the vascular endothelial cells

BackgroundReduced supplies of oxygen and nutrients caused by vascular injury lead to difficult-to-heal pressure ulcers (PU) in clinical practice. Rapid vascular repair in the skin wound is the key to the resolution of this challenge, but clinical measures are still limited. We described the beneficial effects of extracellular vesicle-derived silk fibroin nanoparticles (NPs) loaded with milk fat globule EGF factor 8 (MFGE8) on accelerating skin blood vessel and PU healing by targeting CD13 in the vascular endothelial cells (VECs).MethodsCD13, the specific targeting protein of NGR, and MFGE8, an inhibitor of ferroptosis, were detected in VECs and PU tissues. Then, NPs were synthesized via silk fibroin, and MFGE8-coated NPs (NPs@MFGE8) were assembled via loading purified protein MFGE8 produced by Chinese hamster ovary cells. Lentivirus was used to over-express MFGE8 in VECs and obtained MFGE8-engineered extracellular vesicles (EVs-MFGE8) secreted by these VECs. The inhibitory effect of EVs-MFGE8 or NPs@MFGE8 on ferroptosis was detected in vitro. The NGR peptide cross-linked with NPs@MFGE8 was assembled into NGR-NPs@MFGE8. Collagen and silk fibroin were used to synthesize the silk fibroin/collagen hydrogel. After being loaded with NGR-NPs@MFGE8, silk fibroin/collagen hydrogel sustained-release carrier was synthesized to investigate the repair effect on PU in vivo.ResultsMFGE8 was decreased, and CD13 was increased in PU tissues. Similar to the effect of EVs-MFGE8 on inhibiting ferroptosis, NPs@MFGE8 could inhibit the mitochondrial autophagy-induced ferroptosis of VECs. Compared with the hydrogels loaded with NPs or NPs@MFGE8, the hydrogels loaded with NGR-NPs@MFGE8 consistently released NGR-NPs@MFGE8 targeting CD13 in VECs, thereby inhibiting mitochondrial autophagy and ferroptosis caused by hypoxia and accelerating wound healing effectively in rats.ConclusionsThe silk fibroin/collagen hydrogel sustained-release carrier loaded with NGR-NPs@MFGE8 was of great significance to use as a wound dressing to inhibit the ferroptosis of VECs by targeting CD13 in PU tissues, preventing PU formation and promoting wound healing.Graphical

The prognostic effect of lymphocyte, monocyte, and platelet counts, mean platelet volume, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio on different stages of pressure ulcers

Background/Aim: Pressure ulcers (PU) pose a significant problem for patients in intensive care. Various factors contribute to the development of pressure sores. The primary focus of treatment is to implement measures that prevent factors such as nutrition and positioning, which can lead to PUs. Therefore, it is crucial to identify parameters that can serve as warning signals for the formation and progression of PU. This study investigates the potential use of hematological parameters as warning signals. Methods: Demographic data, co-morbidities, PU stages, and laboratory parameters of 158 patients hospitalized in the intensive care unit who developed pressure ulcers during their hospital stay were recorded and analyzed. Results: Among the 158 cases included in the study, PUs were more prevalent in patients of advanced age, those with pneumonia, chronic obstructive pulmonary disease (COPD), coronary diseases, and neurodegenerative diseases. Mean platelet volume (MPV) was significantly higher in PU stages 2 and 3 compared to stage 1. However, age, lymphocyte count, monocyte count, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) did not exhibit significant differences among the stages of PU (P&lt;0.05). Conclusion: Advanced age, pneumonia, COPD, coronary diseases, and neurodegenerative diseases are identified as risk factors for PU. Although MPV was initially considered a potential, stimulating parameter, the evidence was insufficient. Further research is required to explore this issue. The impact of parameters other than MPV did not show any excitatory signal in this study.

A pressure monitoring approach for pressure ulcer prevention

BackgroundA pressure ulcer (PU) is a debilitating condition that disproportionately affects people with impaired mobility. PUs facilitate tissue damage due to prolonged unrelieved pressure, degrading quality of life with a considerable socio-economic impact. While rapid treatment is crucial, an effective prevention strategy may help avoid the development of PUs altogether. While pressure monitoring is currently used in PU prevention, available monitoring approaches are not formalised and do not appropriately account for accumulation and relief of the effect of an applied pressure over a prolonged duration. The aim of this study was to define an approach that incorporates the accumulation and relief of an applied load to enable continuous pressure monitoring.ResultsA tunable continuous pressure magnitude and duration monitoring approach that can account for accumulated damaging effect of an applied pressure and pressure relief over a prolonged period is proposed. Unlike classic pressure monitoring approaches, the presented method provides ongoing indication of the net impact of a load during and after loading.ConclusionsThe tunable continuous pressure magnitude and duration monitoring approach proposed here may further development towards formalised pressure monitoring approaches that aim to provide information on the risk of PU formation in real-time.

Keratinocyte-Specific SOX2 Overexpression Suppressed Pressure Ulcer Formation after Cutaneous Ischemia–Reperfusion Injury via Enhancement of Amphiregulin Production

Ischemia-reperfusion (I/R) injury is a key player in the pathogeneses of pressure ulcer formation. Our previous work demonstrated that inducing the transcription factor SOX2 promotes cutaneous wound healing through EGFR signaling pathway enhancement. However, its protective effect on cutaneous I/R injury was not well-characterized. We aimed to assess the role of SOX2 in cutaneous I/R injury and the tissue-protective effect of SOX2 induction in keratinocytes (KCs) in cutaneous I/R injury. SOX2 was transiently expressed in KCs after cutaneous I/R injury. Ulcer formation was significantly suppressed in KC-specific SOX2-overexpressing mice. SOX2 in skin KCs significantly suppressed the infiltrating inflammatory cells, apoptotic cells, vascular damage, and hypoxic areas in cutaneous I/R injury. Oxidative stress-induced mRNA levels of inflammatory cytokine expression were suppressed, and antioxidant stress factors and amphiregulin were elevated by SOX2 induction in skin KCs. Recombinant amphiregulin administration suppressed pressure ulcer development after cutaneous I/R injury in mice and suppressed oxidative stress-induced ROS production and apoptosis invitro. These findings support that SOX2 in KCs might regulate cutaneous I/R injury through amphiregulin production, resulting in oxidative stress suppression. Recombinant amphiregulin can be a potential therapeutic agent for cutaneous I/R injury.

1496 Transcription factor SOX2-induced amphiregulin inhibits pressure ulcer formation via suppressing oxidative stress after cutaneous ischemia-reperfusion in mice

1496 Transcription factor SOX2-induced amphiregulin inhibits pressure ulcer formation via suppressing oxidative stress after cutaneous ischemia-reperfusion in mice

The healing effect of topical tea tree oil on pressure ulcers in a rat model.

Objective: The effects of topical tea tree oil (TTO) on the healing of pressure ulcers (PUs) in an animal model was evaluated. Method: To induce PUs, ischaemia-reperfusion cycles were performed by the external application of magnetic plates, with an ischaemic period of eight hours and a reperfusion period of 16 hours. Male and female Wistar rats were divided into three equally sized groups (n=20): one group received topical glycerin twice daily, another group received topical 10% (volume/volume (v/v)) TTO in glycerin twice daily; and the remaining group was untreated. The animals were assessed after one, four, seven and 14 cycles of ischaemia-reperfusion by thermal camera imaging, and then euthanised and sampled to investigate the degree of inflammation, collagen synthesis and apoptosis in the PUs. Results: Although topical glycerin alone suppressed local inflammation and apoptosis, this suppressive effect was accentuated at all timepoints by the application of topical TTO + glycerin. Similarly, an increase in collagen synthesis was observed in the glycerin group and this was accentuated by TTO at all timepoints. Parallel to the histological findings, the local temperature had decreased significantly on days 4 and 7 for both treatment groups (glycerin and TTO+glycerin). Conclusion: In this study, treatment with 10% (v/v) TTO in glycerin effectively suppressed skin inflammation and apoptosis, while it increased collagen synthesis during PU formation.

Protective effects of conditioned media of immortalized stem cells from human exfoliated deciduous teeth on pressure ulcer formation.

Pressure ulcers (PUs) are increasing with aging worldwide, but there is no effective causal therapy. Although mesenchymal stem cells (MSCs) promote cutaneous wound healing, the effects of the conditioned medium (CM) of MSCs on cutaneous PU formation induced by ischemia-reperfusion injury have been poorly investigated. To address this issue, herein, we first established an immortalized stem cell line from human exfoliated deciduous teeth (SHED). This cell line was revealed to have superior characteristics in that it grows infinitely and vigorously, and stably and consistently secretes a variety of cytokines. Using the CM obtained from the immortalized SHED cell line, we investigated the therapeutic potential on a cutaneous ischemia-reperfusion mouse model for PU formation using two magnetic plates. This is the first study to show that CM from immortalized SHEDs exerts therapeutic effects on PU formation by promoting angiogenesis and oxidative stress resistance through vascular endothelial growth factor and hepatocyte growth factor. Thus, the CM of MSCs has potent therapeutic effects, whereas these therapies have not been implemented in human medicine. To try to meet the regulatory requirements for manufacturing and quality control as much as possible, it is necessary to produce CM that is consistently safe and effective. The immortalization of stem cells could be one of the breakthroughs to meet the regulatory requirements and consequently open up a novel avenue to create a novel type of cell-free regenerative medicine, although further investigation into the quality control is warranted.

Which factors are effective in the formation of pressure ulcers in Intensive Care Units in the Cardiac Center?

Which factors are effective in the formation of pressure ulcers in Intensive Care Units in the Cardiac Center?

601 Overexpression of the transcription factor SOX2 in keratinocytes inhibits pressure ulcer formation after cutaneous I/R injury

It is empirically known that wounds on the oral mucosa heal faster than those on the skin, and comparative molecular profiling using human subject from oral mucosa and skin tissue has revealed that the transcription factor SOX2, which is highly expressed in the oral mucosa but not in the skin, activates the mucosal epithelium in the steady state, creating an environment conducive to wound healing. Recent study demonstrated that cutaneous wound healing in epidermal specific SOX2-overexpresing mice was promoted compared with control mice.

The Peripheral Lymphatic System Is Impaired by the Loss of Neuronal Control Associated with Chronic Spinal Cord Injury

Spinal cord injury (SCI) is associated with venous vascular dysfunction below the level of injury, resulting in dysregulation of tissue fluid homeostasis in afflicted skin. The purpose of this study was to determine whether loss of neuronal control in chronic SCI also affects the skin lymphatic system. Morphology of lymphatics was characterized by immunohistochemistry and lymphatic gene expression profiles determined by DNA microarray analysis. In SCI, skin lymphatic function appeared to be impaired, because the ratio of functionally dilated versus collapsed lymphatic vessels was decreased 10-fold compared with control. Consequently, the average lumen area of lymphatic vessels was almost halved, possibly due to the known impaired connective tissue integrity of SCI skin. In fact, collagenases were found to be overexpressed in SCI skin, and dermal collagen structure was impaired. Molecular profiling also suggested an SCI-specific phenotype of increased connective tissue turnover and decreased lymphatic contractility. The total number of lymphatic vessels in SCI skin, however, was doubled, pointing to enhanced lymphangiogenesis. In conclusion, these data show, for the first time, that lymphatic function and development in human skin are under neuronal control. Because peripheral venous and lymphatic vascular defects are associated with disturbed fluid homeostasis, inappropriate wound healing reactions, and impaired skin immunity, they might contribute to the predisposition of afflicted individuals to pressure ulcer formation and wound healing disorders.

Replacement of post-traumatic skin defects in children by tissue stretching with the use of endo-expanders

In the clinic for pediatric trauma, CITO, replacement of post-traumatic skin defects by tissue stretching was performed in 11 patients aged 4 to 14 years. 16 expanders were implanted (5 patients with two expanders). Implantation was performed on the lower leg (5 patients), in the projection of the knee joint (2), on the hand, thigh, scalp and in Filatov's stem (one patient each). The area of ​​the replaced cicatricial defects was 20 cm2 on the hand, up to 135 cm2 on the lower leg, and 160 cm2 on the scalp. Preference will be given to double-expander stretching with expanders located on opposite sides of the cicatricial defect. Among the complications, the formation of pressure ulcers of the skin over the valve tube, violation of the tightness of the balloons were noted. Out of 11 patients, the desired result was obtained in 9. The method of tissue stretching with the help of expanders can be used in children to replace post-traumatic defects of the skin of the limbs and scalp.