Skip to main content
SpringerLink
Log in

Decubitus ulcer development: pressure alone increases tissue temperature

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Pressure ulcers of the buttocks in persons confined to wheel-chairs can be a serious problem. The reduction in blood flow to the tissues caused by the pressure from the ischial tuberosities is a key factor in pressure ulcer development of the buttocks. Also, increase in tissue temperature due to surface insulation, or systemic temperature increase, are risk factors in pressure ulcer development. The aim of this study was to investigate the effect on skin temperature of pressure alone, regardless of surface insulation. Able-bodied, healthy individuals (n = 12) were subjected to an increase in pressure of the tissues overlaying the left ischial tuberosity up to 320 mmHg. The skin temperature was measured on the loaded left buttock half and on the unloaded right buttock half for control. The skin temperature increased significantly 2.7 (0.4)°C (men) and 2.7 (0.6)°C (women) on the loaded left side (p < 0.001 for both groups). When pressure was relieved, a period of hyperemia followed, this increased the temperature further significantly (2.0 (1.0)°C (men, p < 0.01) and 1.3 (0.6)°C (women, p < 0.05)). During hyperemia, maximum temperature was reached after 366 (257) s (women) and 266 (88) s (men). In conclusion, the increase in temperature is most likely to be caused by facilitated heat conduction from the body core caused by compression of the tissues. An increase in temperature as a result of loading may make the tissues even more vulnerable to pressure-induced ischemia due to an increase in metabolic demand.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ferrell BA, Josephson K, Norvid P, Alcorn H (2000) Pressure ulcers among patients admitted to home care. J Am Geriatr Soc 9:1042–1047

    Google Scholar 

  2. Fuhrer MJ, Garber SL, Rintala DH, Clearman R, Hart KA (1993) Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Arch Phys Med Rehabil 11:1172–1177

    Google Scholar 

  3. Makhsous M, Priebe M, Bankard J, Rowles D, Zeigler M, Chen D et al (2007) Measuring tissue perfusion during pressure relief maneuvers: insights into preventing pressure ulcers. J Spinal Cord Med 5:497–507

    Google Scholar 

  4. Smith BM, Guihan M, LaVela SL, Garber SL (2008) Factors predicting pressure ulcers in veterans with spinal cord injuries. Am J Phys Med Rehabil 9:750–757

    Article  Google Scholar 

  5. Allman RM (1997) Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med 3:421–436

    Google Scholar 

  6. Lindgren M, Unosson M, Krantz AM, Ek AC (2002) A risk assessment scale for the prediction of pressure sore development: reliability and validity. J Adv Nurs 2:190–199

    Article  Google Scholar 

  7. Sae-Sia W, Wipke-Tevis DD, Williams DA (2005) Elevated sacral skin temperature (T(s)): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Appl Nurs Res 1:29–35

    Article  Google Scholar 

  8. Stewart SF, Palmieri V, Cochran GV (1980) Wheelchair cushion effect on skin temperature, heat flux, and relative humidity. Arch Phys Med Rehabil 5:229–233

    Google Scholar 

  9. Analyse-it for Microsoft Excel. 2.12 ed. Leeds: Analyse-it Software, Ltd. 2008

  10. Johnson RL, Gerhart KA, McCray J, Menconi JC, Whiteneck GG (1998) Secondary conditions following spinal cord injury in a population-based sample. Spinal Cord 1:45–50

    Article  Google Scholar 

  11. Kroger K, Niebel W, Maier I, Stausberg J, Gerber V, Schwarzkopf A (2008) Prevalence of pressure ulcers in hospitalized patients in Germany in 2005: data from the Federal Statistical Office. Gerontology

  12. Thorfinn J, Sjoberg F, Lidman D (2002) Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study. Scand J Plast Reconstr Surg Hand Surg 5:279–283

    Article  Google Scholar 

  13. Thorfinn J, Sjoberg F, Lidman D (2007) Perfusion of buttock skin in healthy volunteers after long and short repetitive loading evaluated by laser Doppler perfusion imager. Scand J Plast Reconstr Surg Hand Surg 6:297–302

    Article  Google Scholar 

  14. Thorfinn J, Sjoberg F, Sjostrand L, Lidman D (2006) Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load. Scand J Plast Reconstr Surg Hand Surg 3:153–160

    Article  Google Scholar 

  15. Thorfinn J, Sjoberg F, Lidman D (2009) Sitting can cause ischaemia in the subcutaneous tissue of the buttocks, which implicates multilayer tissue damage in the development of pressure ulcers. Scand J Plast Reconstr Surg Hand Surg 2:82–89

    Article  Google Scholar 

Download references

Acknowledgments

This study has been supported by the Swedish Fulbright Commission, the County Council of Östergötland (Sweden), the Medical Research Council of Southeast Sweden, Börje Gabrielsson’s Memorial Fund, the Swedish Society of Medicine, the Johan & Jakob Söderberg Foundation, and the Linköping Society of Medicine.

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Stanford, CA, 94305, USA

    Ioannis K. Angelidis & Johan Thorfinn

  2. Department of Plastic Surgery, Hand Surgery, and Burns, University Hospital, 58185, Linköping, Sweden

    Disa Lidman, Folke Sjöberg & Johan Thorfinn

Authors
  1. Ioannis K. Angelidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Disa Lidman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Folke Sjöberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johan Thorfinn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johan Thorfinn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Angelidis, I.K., Lidman, D., Sjöberg, F. et al. Decubitus ulcer development: pressure alone increases tissue temperature. Eur J Plast Surg 32, 241–244 (2009). https://doi.org/10.1007/s00238-009-0351-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-009-0351-6

Keywords

Search

Navigation