Effects of Compressive Loading Regimens on Tissue Viability

  • Dan L. Bader


The peak pressures and the pressure gradients, present at the interface between the soft tissues and patient support, are considered to be one of the primary initiating factors in tissue breakdown. These interface pressures are transmitted through the soft tissues, establishing interstitial stresses and strains, which may be sufficient to impair the integrity of the local blood supply and lymphatic circulation. If the interface pressure is maintained then cell necrosis will follow, leading to tissue breakdown and the development of pressure sores. The mechanical nature of the soft tissues will undoubtedly influence the breakdown process. Hence, areas with minimal soft-tissue covering over bony prominences are more susceptible to breakdown than is an area with significant subcutaneous tissue and reduced mechanical stiffness.


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  1. Bader, D. L. and Gant, C. A. (1985). Effects of prolonged loading on tissue oxygen levels. In Spence, V. A. and Sheldon, C. D. (eds), Practical Aspects of Skin Blood Flow Measurements, Biological Engineering Society, London, pp. 82–85Google Scholar
  2. Bader, D. L. and Gant, C. A. (1988). Changes in transcutaneous oxygen tension as a result of prolonged pressures at the sacrum. Clin. Phys. Physiol. Meas., 9, 33–40PubMedCrossRefGoogle Scholar
  3. Bader, D. L. and Hawken, M. B. (1986). Pressure distribution under the ischium of normal subjects. J. Biomed. Eng., 8, 353–357PubMedCrossRefGoogle Scholar
  4. Bader, D. L., Evans, R. and Beavis, A. (1986). The effects of repeated loading on tissue viability. Oxford Orthopaedic Engineering Centre Annual Report No. 13, pp. 49–51Google Scholar
  5. Bennett, L., Kavner, D., Lee, B. Y., Trainor, F. S. and Lewis, J. M. (1984). Skin stress and blood flow in sitting paraplegic patients. Arch. Phys. Med. Rehabil., 65, 186–190PubMedGoogle Scholar
  6. Brand, P. W. (1976). Pressure sores - the problem. In Kenedi, R. M., Cowden, J. M. and Scales, J. T. (eds), Bedsore Biomechanics, Macmillan Press, London and Basingstoke, pp. 19–23Google Scholar
  7. Daly, C. H., Chimoskey, J. E., Holloway, G. A. and Kennedy, D. (1976). The effect of pressure loading on the blood flow rate in the human skin. In Kenedi, R. M., Cowden, J. M. and Scales, J. T. (eds), Bedsore Biomechanics, Macmillan Press, London, pp. 69–77Google Scholar
  8. Daniel, R. K., Priest, D. L. and Wheatley, D. D. (1981). Etiological factors in pressure sores: an experimental model. Arch. Phys. Med. Rehabil., 62, 492–498PubMedGoogle Scholar
  9. Dowd, G. E., Linge, K. and Bentley, G. (1983). The effect of age and sex on normal volunteers upon the transcutaneous oxygen tension in the lower limb. Clin. Phys. Physiol. Meas., 4, 65–68PubMedCrossRefGoogle Scholar
  10. Ek, A.-C, Lewis, D. H., Zetterqvist, H. and Svensson, P.-G. (1984). Skin blood flow in an area at risk for pressure sore. Scan. J. Rehab. Med., 16, 85–89Google Scholar
  11. Fisher, S. V. and Patterson, P. (1983). Long-term pressure recordings under the ischial tuberosities of tetraplegics. Paraplegia, 21, 99–106PubMedCrossRefGoogle Scholar
  12. Griffith, B. H. (1963). Advances in the treatment of decubitus ulcers. Surg. Clinic. N. America, 43, 245–260Google Scholar
  13. Larsen, B., Holstein, P. and Lassen, N. A. (1979). On the pathogenesis of pressure sores. Skin blood flow cessation by external pressure on the back. Scand. J. Plas. Reconstr. Surg., 13, 347–350CrossRefGoogle Scholar
  14. Merbitz, C. T., King, R. B., Bleiberg, J. and Grip, J. C. (1985). Wheelchair push-ups: measuring pressure relief frequency. Arch. Phys. Med. Rehabil., 66, 433–438PubMedGoogle Scholar
  15. Newson, T. P. and Rolfe, P. (1982). Skin surface PO2 and blood flow measurements over the ischial tuberosity. Arch. Phys. Med. Rehabil., 63, 553–556PubMedGoogle Scholar
  16. Reswick, J. B. and Rogers, J. E. (1976). Experience at Rancho Los Amigos Hospital with devices and techniques to prevent pressure sores. In Kenedi, R. M., Cowden, J. M. and Scales, J. T. (eds), Bedsore Biomechanics, Macmillan Press, London and Basingstoke, pp. 301–310Google Scholar
  17. Ryan, T. J. (1973). Structure pattern and shape of the blood vessels of the skin. In Jarrett, A. (ed.), The Physiology and Pathophysiology of the Skin, Academic Press, London, pp. 577–651Google Scholar
  18. Sacks, A. H., O’Neil, H. and Perkash, I. (1985). Skin blood flow changes and tissue deformations produced by cylindrical indentors. J. Rehab. Res. Dev., 22, 1–6CrossRefGoogle Scholar
  19. Sacks, A. H., Perkash, I. and O’Neil, H. (1986). Skin deformation and blood flow under external loading. V. A. Rehabilitation R&D Progress Reports, pp. 97–98Google Scholar
  20. Young, K. C, Railton, R., Harrower, A. D. et al. (1981). Transcutaneous oxygen tension measurements as a method of assessing peripheral vascular disease. Clin. Phys. Physiol. Meas., 2, 147–151PubMedCrossRefGoogle Scholar

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© The editor and contributors 1990

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  • Dan L. Bader

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