The 2019 international pressure ulcer guideline: aetiology chapter

The Aetiology Chapter of the 2019 International Pressure Ulcer Prevention and Treatment Guideline¹ is a comprehensive synthesis of contemporary research findings and discoveries concerning the prevention and treatment of pressure ulcers (PUs). PUs make up a substantial portion of all hard-to-heal wounds and are associated with huge healthcare costs. Bioengineering research over the last 20 years, as described in the guideline, has explained why a naïve approach—seeking absolute and generic tissue injury thresholds to predict when PUs may occur—will forever remain intangible (despite the investment of clinicians, academia and industry in trying to determine such thresholds). Yet, there are promising routes for constructive future bioengineering work that will likely lead to better PU prevention and treatment, even if, there are currently no straightforward injury thresholds to predict when a specific patient might develop these potentially devastating wounds. The hope that such generic injury thresholds may exist has halted productive progress in PU research for decades.²