Skin Failure Research Articles

Hospital-Acquired Pressure Injuries and Acute Skin Failure in Critical Care: A Case-Control Study.

The purpose of this study was to examine clinical characteristics and risk factors for critically ill patients who develop pressure injuries and identify the proportion of validated unavoidable pressure injuries associated with the proposed risk factors for acute skin failure (ASF). Retrospective case-control comparative study. The sample comprised adult critically ill participants hospitalized in critical care units such as surgical, trauma, cardiovascular surgical, cardiac, neuro, and medical intensive care and corresponding progressive care units in 5 acute care hospitals within a large Midwestern academic/teaching healthcare system. Participants who developed hospital-acquired pressure injuries (HAPIs) and patients without HAPIs (controls) were included. A secondary analysis of data from a previous study with HAPIs and matching data for the control sample without HAPIs were obtained from the electronic health record. Descriptive and multivariate logistic regression analyses were conducted. The sample comprised 475 participants; 165 experienced a HAPI and acted as cases, whereas the remaining 310 acted as controls. Acute Physiology and Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001), mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P < .001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002) were higher in the HAPI group. Multivariate logistic regression analysis identified participants with respiratory failure (odds ratio [OR] = 3.00; 95% confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI, 3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002), severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR = 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95% CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences between unavoidable HAPI, avoidable HAPI, or the control group were identified based on the proposed ASF risk factors. This study provides important information regarding avoidable and unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as patient acuity, organ failure, tissue perfusion, sepsis, and history of prior pressure injury, are associated with avoidable and unavoidable HAPI development. In addition, we were unable to support a relationship between unavoidable HAPIs and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the documentation of appropriate interventions and not necessarily with the identification of clinical risk factors.

Pediatric dermatological emergencies in tertiary health care

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;In recent years, the demand for dermatological consultations in the emergency department has increased. However, most of the publications of dermatological emergencies deal with the general population, without taking into account the changes in frequencies found in young children (ages 0-14 years). Dermatological emergencies in pediatric age group are not uncommon. The aim of our study was to analyse the spectrum of dermatological emergencies in the pediatric age group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital‑based observational study was conducted at the Department of Dermatology of tertiary care centre, between September 2019 and February 2020. Thirty pediatric patients (age ≤16 years) who had visited Dermatology Outpatient Department (OPD) and emergency department were included in this study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total thirty patients were included in this study. The male to female ratio was 2:1. The average age of the study was 7.6 years. Maximum cases were in school-aged children (6 to 12 years), which were 12 (40%). The average duration of illness was 36.04 days. The most common condition was inherited conditions (23%) followed by primary cutaneous infections (20%). The cases were divided as 7 (23%) inherited conditions, 6 (20%) cases of infections, 5 (17%) cases each of vasculitis and cutaneous adverse drug reaction and 7 (23%) miscellaneous cases.&lt;/p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pediatric dermatological emergencies require an interdisciplinary approach for timely intervention. Standardised protocol should be followed in their management to prevent complications like acute skin failure. Early referral of these patients with primary skin conditions to the dermatologists might result in better clinical outcome and decreased mortality. &lt;p&gt; &lt;/p&gt;

Dermatological Manifestations in the Intensive Care Unit: A Practical Approach.

Dermatological problems are not usually related to intensive medicine because they are considered to have a low impact on the evolution of critical patients. Despite this, dermatological manifestations (DMs) are relatively frequent in critically ill patients. In rare cases, DMs will be the main diagnosis and will require intensive treatment due to acute skin failure. In contrast, DMs can be a reflection of underlying systemic diseases, and their identification may be key to their diagnosis. On other occasions, DMs are lesions that appear in the evolution of critical patients and are due to factors derived from the stay or intensive treatment. Lastly, DMs can accompany patients and must be taken into account in the comprehensive pathology management. Several factors must be considered when addressing DMs: on the one hand, the moment of appearance, morphology, location, and associated treatment and, on the other hand, aetiopathogenesis and classification of the cutaneous lesion. DMs can be classified into 4 groups: life-threatening DMs (uncommon but compromise the patient's life); DMs associated with systemic diseases where skin lesions accompany the pathology that requires admission to the intensive care unit (ICU); DMs secondary to the management of the critical patient that considers the cutaneous manifestations that appear in the evolution mainly of infectious or allergic origin; and DMs previously present in the patient and unrelated to the critical process. This review provides a characterization of DMs in ICU patients to establish a better identification and classification and to understand their interrelation with critical illnesses.

Structural analysis and strength-to-weight optimization of wood-based sandwich composite with honeycomb core under three-point flexural test

Wood-based sandwich composite with a paper honeycomb core, especially for thick boards, has the advantage of high strength-to-weight ratio for the use in lightweight furniture products, interior walls etc. Employing both theoretical and experimental methods, this study investigated the influencing factors of various failure modes and its transition to obtain optimized structural parameters after a quasi-static load was applied. The results reveal that the skins of MDF are too strong for the paper honeycomb core. Both failure modes are caused by weak core properties. If the thickness or strength of the skins could be reduced or the core strength could be reinforced, then optimal failure mode of simultaneous core and skin failure could be reached. The intersection point of three transition lines is the best combination of structural parameters, meaning highest strength-to-weight ratio. At this point, failure of core shear, indentation and face fracture occurs simultaneously. The distance from a structural parameter to intersection is an effective index to express the degree of optimization for the strength-to-weight ratio of composites. Specimens close to the intersection point have optimal structural parameters and high strength-to-weight ratio. On application level, the optimum strength-to-weight ratio could be obtained easily by adjusting the surface or core thickness, if the materials were fixed first.

Deformation and damage evolution of a full-scale adhesive joint between a steel bracket and a sandwich panel for naval application

The increasing interest for the application of adhesive joints in naval superstructures motivates researchers to gain an in-depth understanding of the mechanical behaviour and failure mechanisms of these joints. This work reports on an experimental study of the deformation behaviour and damage evolution of a full-scale multi-material joint using different instrumentation techniques. Adhesively bonded joints of steel to sandwich panel components have been subjected to quasi-static tensile tests during which the global deformation of the joint and local strain distributions were monitored using digital image correlation (DIC). During one particular tensile test, fibre optic Bragg sensors (FBG) were also applied to the specimen’s surface at different locations in order to quantify the evolution of local strains. Additionally, acoustic emission (AE) sensors were installed in order to monitor damage initiation and evolution with increasing levels of imposed deformation. This test showcased adhesive failure at the interface of the steel adherend and the adhesive, while cohesive failure was observed within the adhesive and skin failure at the interface between adhesive and the composite skin of the sandwich panel. The post-mortem observed failures modes were compared to the acoustic events that originated during the test due to damage initiation and propagation within the joint. The evolution of the different sensor signals, i.e. the damage expressed as cumulative AE energy and local strains measured with Bragg sensors and DIC, are mutually compared and acceptable correlation is found.

Skin failure in patients with a terminal illness

Skin failure in patients with a terminal illness

Skin failure in patients with a terminal illness

Skin changes related to the dying process are different from other types of pressure injuries.

The Phenomenon of Trombley-Brennan Terminal Tissue Injury in a Neonate

Trombley-Brennan terminal tissue injury (TB-TTI), also known as skin failure, was first identified in 2009 among critically ill adults receiving palliative care. Identification of this skin injury can be misinterpreted as a pressure ulcer. However, this phenomenon is now accepted as an early sign of impending death among critically ill adults. This case study describes TB-TTI in a terminally ill infant in a neonatal intensive care unit evidenced by intact, 2-cm oval skin discoloration on the lateral side of both knees with rapid progression in size. TB-TTI was identified on the day of death in an infant with a primary diagnosis of hypoxic-ischemic encephalopathy born at 32 weeks' gestation. The neonatal intensive care unit (NICU) team mobilized the NICU advanced care team, institution's ethical council, and "Team Lavender" to provide infant comfort measures and emotional support to the family and care givers. Infant death occurred 8 hours after TB-TTI was identified. To our knowledge, this case study of TB-TTI in a terminally ill neonate in the NICU has not been previously described in the neonatal or pediatric population. Early recognition of the phenomenon can enable the healthcare team to provide timely emotional, spiritual, and psychosocial support to the family and allow time to "be present" with the infant at "end of life." Future work should explore additional signs of TB-TTI and the occurrence rate.

Acute Skin Failure in the Critical Care Patient.

The purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population. Researchers conducted a retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model. Eleven variables were significantly and independently related to ASF: renal failure (odds ratio [OR], 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively. The final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.

«Acute skin failure», unreasonably lost term

Objective: to present data and analyze current data on diagnostics of acute skin failure in children. The term “acute skin failure” is rarely used in the literature. Among the works published in Russian, we found only one study of our colleagues from the Republic of Belarus, where we met the definition and description of this term. When searching the Pubmed database, we found 58 scientific works, only 7 of them were devoted to children. When determining the presence or absence of multiple organ failure syndrome, none of the scales used for adults and children included skin disorders. The majority of scales described changes in the respiratory system, kidneys, liver, cardiovascular system, neurological status and blood system. However, acute skin failure is a serious problem similar to insufficiency of internal organs. The clinical case demonstrates the possibility of effective intensive care in a child with acute skin failure. We believe that the diagnosis of acute skin failure as a primary or secondary component of multiple organ failure syndrome in children in the intensive care unit is an important step towards the correct and adequate treatment of such patients.

Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries: Results of the 2019 Terminology Survey.

To present the results of the 2019 study of healthcare professionals' consensus and opinions regarding terminology for terminal ulcers, Skin Changes At Life's End, skin failure, and unavoidable pressure injuries to improve clinical care and to foster research into current criteria for unavoidable skin changes at the end of life. This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. After completing this continuing education activity, the participant should be better able to:1. Explain the survey methodology and identify the consensus statements.2. Synthesize the open-ended questions and respondent comments and their implications for clinical care and research. This article reports the results of a global wound care community survey on Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, skin failure, and unavoidable pressure injury terminology. The survey consisted of 10 respondent-ranked statements to determine their level of agreement. There were 505 respondents documented. Each statement required 80% of respondents to agree (either "strongly agree" or "somewhat agree") for the statement to reach consensus. Nine of the 10 statements reached consensus. Comments from two additional open-ended questions were grouped by theme. Conclusions and suggested recommendations for next steps are discussed. This summary is designed to improve clinical care and foster research into current criteria for unavoidable skin changes at the end of life.

Terminal ulcers, SCALE, skin failure, and unavoidable pressure injuries: results of the 2019 Terminology Survey

Terminal ulcers, SCALE, skin failure, and unavoidable pressure injuries: results of the 2019 Terminology Survey

Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries: Results of the 2019 Terminology Survey.

Advances in Skin & Wound Care: March 2020 - Volume 33 - Issue 3 - p 1-2 doi: 10.1097/01.ASW.0000654588.32193.6a

Swelling of cell walls in mature sweet cherry fruit: factors and mechanisms

Main conclusionSwelling of sweet cherry cell walls is a physical process counterbalanced by turgor. Cell turgor prevents swelling in intact cells, whereas loss of turgor allows cell walls to swell.Swelling of epidermal cell walls precedes skin failure in sweet cherry (Prunus avium) cracking. Swollen cell walls lead to diminished cell:cell adhesions. We identify the mechanism of cell wall swelling. Swelling was quantified microscopically on epidermal sections following freeze/thaw treatment or by determining swelling pressure or swelling capacity of cell wall extracts. Releasing turgor by a freeze/thaw treatment increased cell wall thickness 1.6-fold within 2 h. Pressurizing cell wall extracts at > 12 kPa prevented swelling in water, while releasing the pressure increased swelling. The effect was fully reversible. Across cultivars, cell wall thickness before and after turgor release in two subsequent seasons was significantly correlated (before release of turgor: r = 0.71**, n = 14; after release of turgor: r = 0.73**, n = 14) as was the swelling of cell walls upon turgor release (r = 0.71**, n = 14). Close relationships were also identified for cell wall thickness of fruit of the same cultivars grown in the greenhouse and the field (before release of turgor: r = 0.60, n = 10; after release of turgor: r = 0.78**, n = 10). Release of turgor by heating, plasmolysis, incubation in solvents or surfactants resulted in similar swelling (range 2.0–3.1 µm). Cell wall swelling increased from 1.4 to 3.0 µm as pH increased from pH 2.0 to 5.0 but remained nearly constant between pH 5.0 and 8.0. Increasing ethanol concentration decreased swelling. Swelling of sweet cherry cell walls is a physical process counterbalanced by turgor.

Wounds Related to Malignancy in Postacute and Long-term Care: A Case Series.

To study the epidemiology and characteristics of wounds related to malignancy in a large, academically affiliated postacute/long-term care (PALTC) facility. Retrospective case series of 1 year of wound care consultations. Inclusion criteria included a cancer diagnosis with wounds related to malignancy or complications from cancer-related debility and/or treatment. Academically affiliated 514-bed PALTC facility. Of 190 consults, 27 residents (14.2%) met the inclusion criteria. Of these, 20 (74.1%) were female, and 7 (25.9%) were male. The average age of residents with a cancer diagnosis and wounds was 69.5 years (range, 48.1-86.7 years), and 25 (92.6%) were on the postacute service. The most common reasons for consultation included pressure injuries (44.4%), surgical wounds (21.4%), and malignant wounds (14.8%). Seventy-six percent of pressure injuries were present on admission. Breast (29.6%), gastrointestinal (25.9%), and gynecologic (11.1%) malignancies were most common. Of the studied residents, 14 (51.9%) had metastases, and 13 (92.9%) had pressure injuries. These findings begin to fill a gap in understanding the spectrum of wounds in PALTC residents with cancer and reinforce the importance of the wound care skill set, including pressure injury prevention. Quality cancer care for older adults must anticipate severe skin complications not only from the tumor and its treatment, but also from the sequelae of immobility, immune compromise, malnutrition, and skin failure. The close association of metastatic disease with pressure injury raises issues of unavoidability and casts new doubt upon the use of pressure injuries for quality measurement.

Acute Skin Failure in the Critically Ill Adult Population: A Systematic Review.

Acute Skin Failure in the Critically Ill Adult Population: A Systematic Review.

Acute Skin Failure in the Critically Ill Adult Population: A Systematic Review.

To present a systematic review of the literature conducted to define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in adult intensive care patients. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Outline the background information helpful for understanding the authors' systematic review of ASF in adult intensive care patients.2. Summarize the results of the authors' review of the risk factors, causes, and antecedent conditions of ASF in adult intensive care patients. To define and extend knowledge of the risk factors, causes, and antecedent conditions of acute skin failure (ASF) in the adult intensive care patient cohort.The Cochrane Library, Joanna Briggs Institute Evidence-Based Practice Database, PubMed, Medical Literature Analysis and Retrieval System, Cumulative Index of Nursing and Allied Health Literature, and Google Scholar.Studies were selected if they were qualitative or quantitative research that reported ASF in adult human patients in an ICU setting. The preliminary search yielded 991 records and 22 full texts were assessed for eligibility. A total of three records were included. Studies were appraised using the Mixed Methods Appraisal Tool.Data from the included studies were extracted by one reviewer and summarized in data collection tables that were checked and verified by a second reviewer.Study authors identified five independent predictors of ASF: peripheral vascular disease, mechanical ventilation longer than 72 hours, respiratory failure, liver failure, and sepsis. However, the term ASF was applied to retrospective cohorts of patients who developed severe pressure injuries. This, combined with the absence of evidence surrounding the assessment, clinical criteria, and diagnosis of ASF, could impact these variables' predictability relative to the condition.These results highlight a substantial evidence gap regarding the etiology, diagnostic biomarkers, and predictors of ASF. Further research focused on these gaps may contribute to an accurate and agreed-upon definition for ASF, as well as improved skin integrity outcomes.

Transfusion-Associated Graft-Versus-Host Disease Confirmed by Human Leukocyte Antigen Typing in a Patient with Severe Combined Immunodeficiency and Review of the Literature

Background: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, but often lethal complication of cellular blood component transfusion that produces a graft-versus-host clinical manifestation in immunodeficient patients. We report a patient who developed TA-GVHD and provide a review of the literature. Method: We report an infant with severe combined immunodeficiency (SCID) who developed TA-GVHD. The patient received a nonirradiated, packed erythrocyte cell suspension and platelet transfusions from unrelated donors, before the diagnosis of SCID. The patient manifested symptoms and signs of TA-GVHD (fever, skin rash, diarrhea, icterus, eosinophilia and bone marrow failure) 3-weeks after blood product transfusions. Result: Immunology investigation was consistent with T– B– NK+ SCID. The recto-sigmoid biopsies confirmed the gold standard features of grade-II acute GVHD. HLA typing of the patient and his parents showed that the patient has an extra-parental-allele of major histocompatibility complex (MHC) class I B*53. He received high doses of methylprednisolone, IVIG and ursodeoxycholic acid, but he had progressive hyperbilirubinemia and bone marrow failure, then he developed candidemia and pseudomonas aeruginosa sepsis and multiorgan failure then he died. Discussion / Conclusion: SCID is one of several risks for TA-GVHD. TA-GVHD develops when transfused blood-derived immunocompetent, alloreactive T lymphocytes able to engraft in the recipient’s lymphoid tissues that fail to reject them. Those lymphocytes mediate immune response causing damage and dysfunction of the skin, gastrointestinal tract, liver and bone marrow failure. Our patient showed all features of TA-GVHD that was complicated by fulminant sepsis and multiorgan failure despite aggressive management. The diagnosis of this lethal condition needs high index of suspicion and the transfusion history must be questioned in all immunodeficiency patients. The disease is fulminate and rapidly fatal in majority of patients even with aggressive treatment, while irradiation of blood products that to be given to recipients at risk is the preventive method of choice.

Infantile systemic hyalinosis: report of a case from Bahrain and review of literature

Background: Infantile systemic hyalinosis (ISH), an allelic form of hyaline fibromatosis syndrome, is a rare fatal autosomal recessive disorder that is caused by mutations in the CMG2/ANTRX2 gene encoding the transmembrane anthrax toxin receptor 2. It has a compound of features due to the accumulation of hyaline material in multiple organs including characteristic skin lesions, joint contractures, persistent diarrhea, and failure to thrive. The resulting severe malnutrition can be the cause of death in early infancy. Due to its rarity and early high fatality rate, timely diagnosis is difficult, and children with ISH may die undiagnosed. Case Presentation: In this report, we describe a 3-year-old female diagnosed with ISH after reviewing her clinical and laboratory workup in Salmaniya Medical Hospital. She was diagnosed with ISH based on the clinical presentation of severe skin lesions, painful joint contractures, and later developed renal tubular acidosis. Her diagnosis was confirmed with skin histopathology and identification of homozygous ANTRX2 mutation, c.652T>C, p.Cys218Arg, and Chr4 (GRCh37): g.80957171A>G. Conclusion: While the clinical outcome of the disease is poor without curative treatment, establishing an early diagnosis of ISH, beginning with clinical suspicion to molecular analysis, is important for accurate management as well as carrier and risk assessment of family members.

Aircraft Fuselage Cracking and Simulation

The fatigue failure is predominate in the aircraft fuselage. The fuselage skin consists of the shell and stingers. Fatigue plays a significant role in the crack growth of the skin structures. The proper maintenance and scheduled test intervals may avoid sudden skin failure and crack path (CP). With exiting the cracks, the propagation rate increases dramatically. Therefore, shortening the regular inspection intervals is recommended. Nevertheless, the young machines may have also unexpected skin rupture. The cracks are emanating from the notches such as rivets and the holes under the cyclic loading. The stresses concentrated around these notches. The stress concentration provides the unique conditions for crack initiation. Therefore, the cracks tend to connect with each other. Hence, the number of cycles to failure is decreased dramatically. Although the last decades, the fracture toughness, design, and new alloying element are enhanced. According to the traditional fuselage failure, the crack inspections are recommended even after a few thousand cycles.