References
Changes of tissue images visualised by ultrasonography in the process of pressure ulcer occurrence
Abstract
Objective:
Ultrasonography is suitable for assessing pressure ulcers, and several features of ultrasonographic images that indicate abnormalities have been reported. However, no study has compared ultrasonographic images between normal and pressure-loaded skin and subcutaneous tissue from the same patients. This study aimed to assess lateral thoracic tissue using ultrasonography for both pre- and postoperative conditions and investigate changes in the tissue caused by loading. Surgeries were performed with patients in the park-bench position.
Method:
A nursing researcher obtained ultrasonographic images of the skin and subcutaneous tissue of the lower thoracic region in areas in contact with the surgical table one or two days before and after surgery. This study focused on three groups of two patients who had a category I pressure ulcer (PU), blanchable erythema, or normal skin on their lateral thoracic region.
Results:
A total of six patients participated. Postoperatively, muscle layers became thinner and less clear compared with pre-operative conditions in patients with the Category I pressure ulcers. These patients complained of significant pain in the areas of their pressure ulcers.
Conclusion:
Thickness of muscle layers could be an early sign of deep tissue injury.
Prevalence of postoperative pressure ulcers (PU) (also called pressure injuries) has been reported to be 19%.1 High numbers of postoperative PUs suggest that both preventing PU development and shortening wound healing time by an accurate assessment of the wound pathophysiology are important. Category I PUs are more common than other postoperative injuries.1 A prospective study that followed the healing process of category I PUs reported that four out of 15 PUs deteriorated to category II.2 Understanding the extent of tissue damage at the onset of pressure loading is needed to provide optimal PU management to prevent PU deterioration.
Several methods using wound fluid have been used for PU assessment.3–4 However, these methods cannot be used for the category I PU because the skin remains intact. Methods that visualise changes in internal structures, such as thermography and ultrasonography, have been used in clinical settings.5,6,7–8 In particular, ultrasonography is suitable for observation of superficial to deep tissue structures. Ultrasonography visualises tissue structures using ultrasound waves that reflect at the boundaries between tissues of different density. Previous studies reported that abnormal features in ultrasonographic images of PUs may predict wound prognosis, including deterioration of deep tissue injury (DTI).9–10 A limitation of previous studies using ultrasonographic assessment is that abnormal features reported only images collected after tissue damage had occurred. These studies may have missed some changes in tissue that accompany PUs. Furthermore, although Helvig and Nichols reported abnormal ultrasonographic images of both visible and internal heel PUs,11 the heel anatomy is not representative of other sites due to lack of muscle layers. This study aimed to assess lateral thoracic tissue using ultrasonography among patients who underwent surgery in the park-bench position12 for both pre- and postoperative conditions, and investigate changes in the tissue caused by loading.
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