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National Pressure Ulcer Advisory Panel. Pressure Ulcer Stages/Categories. 2012. http://tinyurl.com/zqj65av (accessed 29 July 2016)

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Ceelen K.K., Stekelenburg A, Loerakker S. Compression-induced damage and internal tissue strains are related. J Biomech. 2008; 41:(16)3399-3404

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Binzoni T., Quaresima V., Barattelli G. Energy metabolism and interstitial fluid displacement in human gastrocnemius during short ischemic cycles. J Appl Physiol. 1998; 85:(4)1244-1251

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The aetiology of deep tissue injury: a literature review

02 January 2017
Volume 1 · Issue 1

Abstract

Deep tissue injury affects patients of all ages in a variety of health-care settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in order to accurately assess the pressure ulcer risk of vulnerable patients, and to subsequently reduce patient harm. The majority of pressure ulcers are avoidable, however, a variety of intrinsic and extrinsic factors can contribute towards the development of deep tissue injury. Understanding the body's internal responses to external pressure will enable nurses to recognise that a visual assessment alone may not necessarily identify patients at risk of deep tissue damage. This article reviews the evidence for the internal causative mechanisms of deep tissue injury, while linking to clinical practice and pressure ulcer prevention.

Pressure ulcers (PU) occur when the skin and/or underlying tissues are damaged owing to pressure or shear forces, impairing blood supply.1 Bed-bound and wheelchair-bound patients, and the neurologically impaired are most vulnerable to developing a severe PU involving necrosis in muscle tissue, which is termed deep tissue injury (DTI).2,3

PUs are associated with reduced health-related quality of life, due to factors such as pain, depression and prolonged hospital stays,4 with DTI linked to serious patient outcomes such as sepsis, renal failure and mortality, imposing a great financial burden on healthcare services.5,6 The total annual expenditure for PU management in the UK is estimated to be between £1.4 and £2.1 billion,7 however, despite the large financial costs, the exact nature of PU development is still not fully understood.8,9

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