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Significance Chronic wounds fail to heal in a timely manner and exhibit sustained inflammation with slow tissue repair and remodelling. They decrease mobility and quality of life, and remain a major clinical challenge in the long-term care of many patients, affecting 6.5 million individuals annually in the U.S., decreasing mobility and quality of life. Treatment costs are a major burden on the U.S. healthcare system, totalling between $25 and $100 billion annually. Chronic wound severity depends upon several factors such as comorbidities, severity of tissue damage, infection and presence of necrosis and vary greatly in their healing mechanisms. In vivo animal models are critical for studying healing pathways of chronic wounds and seek to replicate clinical factors for trials of topical, systemic, and device-based therapeutics. This comprehensive review discusses murine, rat, lapine, canine, feline and porcine models of chronic wounds. Recent advances Foundational chronic wound models for several species are discussed together with refinements and advances in the time period between 2015 and 2020 which have the potential for broad utility in investigating biological and device-based wound treatment therapies for human health. Critical issues Chronic wounds fail to heal in a timely manner and have differing aetiologies, rendering no single in vivo animal model universally applicable. Future directions Further studies are required to develop clinically relevant chronic wound animal model which reflect the clinical reality of the various influences of age, disease, comorbidities and gender on delayed healing and enhance understanding of the biological processes of human wound healing.

The purpose of this quality improvement (QI) project was to develop and implement an interactive, evidence-based pressure injury (PI) education program and evaluate the impact on frontline hospice nursing staff knowledge and practice.The QI setting was a 12-bed inpatient hospice unit in a tertiary care Veterans Affairs (VA) Medical Center in Cleveland, Ohio. Nineteen licensed and unlicensed hospice nursing staff participated in this pre-/postworkshop project.Chart audit determined baseline PI incidence and prevalence on the inpatient hospice unit. Interviews with key leaders informed the need to develop and implement innovative PI education opportunities. A literature review determined existing standards regarding the benefits of PI education for nursing staff but did not reveal measurable targets in hospice settings. We developed a PI education intervention based on Kolcaba's Theory of Comfort framework and a Plan-Do-Study-Act (PDSA) performance improvement model. Education was delivered in 7 workshops, lasting 2 hours each. Knowledge, practice, and comfort for inpatient hospice nursing staff were evaluated at baseline and 8 weeks following the final refresher visit. Workshop satisfaction was collected once using standard program evaluation forms after final workshop delivery.We observed a significant improvement in staff PI knowledge (P = .001) and practice (P = .001) after initial workshop attendance and repeat engagement (P = .001). There was a large magnitude of effect for overall knowledge change (d = 1.04); similarly PI care planning and practice showed a large magnitude of effect and significant improvement (P = .001, d = 2.64). Staff comfort with job duties was stable with low effect size (mean 4.52, d = 0.04), and satisfaction with the workshop education was high (100% agreement with trainer effectiveness).We found that frontline hospice nursing staff knowledge and practice improved after attendance at our evidence-based PI education program. Results of this QI project have stimulated ongoing discussion on how to sustain this program in our hospice setting.

Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

There are a number of cell therapies that are either in clinical trials or moving toward clinical trials, particularly for diseases of the retina. One of the challenges with cell therapies is tracking the status of cells over time. Genetic manipulation can facilitate this, but it can limit the clinical application of the cells. There are a host of fluorophores that have been developed to assess the status of cells, but these molecules tend to be cleared rapidly from cells. There are preclinical strategies that use degradable scaffolds, and we hypothesized that these scaffolds could be used to track the state of cells during preclinical studies. In this work, we explored whether fluorophores could be delivered from simple scaffolds fabricated under extremely harsh conditions, be active upon release, and report on the cells growing on the scaffolds over time. We encapsulated CellROX® Green Reagent, and pHrodo™ Red AM in poly(lactic-co-glycolic acid) (PLGA) scaffolds, showed that they could be delivered over weeks and were still active upon release and taken up by cells. These experiments provide the foundation for using scaffolds to deliver molecules to report on cells.

To investigate intersections between pressure injury (PrI) history, muscle composition, and tissue health responses under physiologically relevant loading conditions for individuals with spinal cord injury (SCI).Repeated measures study design with annual follow-up for up to 3 years.Tertiary care center.Persons with SCI (N=38). Exclusion criteria included having an open pelvic region PrI at the time of recruitment, presence of systemic disease, and/or known sensitivity to contrast.Not applicable.Gluteal muscle composition, ischial interface pressures, tissue oxygenation.Ischial region mean interface pressures are the same for individuals with or without a PrI history. Tissue oxygenation is lower during sitting for persons with a PrI history. Individuals with15% gluteal intramuscular fat were statistically highly significantly (P.001) more likely to have a history of severe or recurrent PrI. Intramuscular adipose tissue (IMAT) levels within the gluteal muscle may remain low over time or muscle tissue in the gluteal muscle region may be almost entirely replaced by IMAT. In the current study cohort, it was found that muscle composition also continues to change over time even for individuals with long-standing SCI.Soft-tissue compositional changes, specifically IMAT, provides a reliable indicator of PrI history and may provide a key to personalized PrI risk status for persons with SCI. The current findings confirm that interface pressure mapping alone is a limited indicator for PrI development.

Background Infected wounds are painful and cannot heal, with antibiotics showing reduced efficacy. Appropriate wound electrotherapy may limit incident planktonic and polymicrobial colonization, inhibit biofilm formation and accelerate healing. Methods The Modular Adaptive Electrotherapy Delivery System (MAEDS) is a lightweight, flexible, battery-powered disposable bandage which delivers controlled reliable electrotherapy to the wound for up to 7 days. Large full-thickness excisional wounds (6 cm diameter) were created in a porcine model and freshly cultured 0.5 McFarland green fluorescent protein-labeled Pseudomonas aeruginosa evenly applied to the wound bed. Control wounds received standard wound care, Tegaderm HP Transparent Dressing (3 M Health Care, St. Paul, MN, USA) applied in a sterile fashion. Treatment wounds received MAEDS electrotherapy for up to 28 days or until healed. Onboard Bluetooth facilitated remote real-time monitoring of MAEDS function. Dressing changes occurred on postoperative day (POD) 1, 3, 5, 7, 10, 14, 21, and 28. Punch biopsies were taken at the wound margin and center. Bacterial samples were processed to determine infection status. Results Acute infected wounds treated with MAEDS electrotherapy were 92% smaller than baseline by POD21. Healing rate was significantly faster (p < 0.01) and infection significantly decreased (p < 0.0001) at POD10, relative to control wounds. Conclusion The MAEDS electrotherapy can significantly inhibit infection and enhance healing rate in acute infected wounds.

The development of flexible electrodes has garnered heightened interest by the wearables community for monitoring and treating human health and performance in a non-invasive and unobtrusive manner. There remains a gap in developing absorbent, biocompatible, flexible, and scalable electrodes for wearable applications. To address this shortcoming, we developed a carbon black-polyvinyl alcohol (CB-PVA) nanocomposite electrode. Glycerol was used to facilitate hydrogen bonding and crosslink the nanocomposite. The material provides high flexibility, electrical conductivity, and demonstrates electrical stability over a long-term duration (5 hours). This simple and cost-effective fabrication method for CB-PVA nanocomposites provides an opportune pathway for various applications in the bioelectronics field.

There is growing understanding that the consumer’s voice in research needs to be stronger. Translational research studies need consumer inclusion in order to be effectively implemented. This narrative article provides the perspective of a Veteran with spinal cord injury (SCI) who is an active member of several study teams and serves as a Consumer Advocate, providing the voice of the person with SCI. Factors that drive people to develop new research ideas are considered. Consumer involvement offers helpful insight into project outcomes that are valuable to the end-user. It is also recognized that data can be interpreted in several different ways depending on the observer. Including the consumer in a research project enables another interpretation, creating a more complete evaluation. Participating in health research is becoming a new standard for persons with many different illnesses and diseases. Greater things are accomplished by physicians, healthcare scientists, engineers, and healthcare consumers interacting together to increase both the quality of research projects and the quality of life for everyone involved, especially the person with the disorder. There will be more acceptance of ideas or projects when consumers are involved from the early steps and learn how the process works from beginning to end.

Objectives The aims of the study were to assess reports of wheelchair mobility-related injuries from inadvertent lower extremity displacement (ILED) on footplates, which were submitted to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database during 2014-2018, characterize injury types, and evaluate MAUDE data quality. Methods A systematic MAUDE database review was performed. Annual reports were searched using keywords: (a) "power wheelchair" and "injury" and (b) "mechanical (also known as manual) wheelchair" and "injury." Reports related to injuries from ILED on the footplate were reviewed. Results Reports of 1075 wheelchair injuries were found across the review period. Twenty nine (3%) met our inclusion criteria. The most common source of reports was "manufacturer." The wheelchair was unavailable for evaluation in 55.17% of reports. Manufacturers' submission dates (number of days that passed after they were notified) ranged from 3 to 159. Reported injuries decreased by 60% from 2014 to 2018. The end user used a power wheelchair for all but one report. The most common injuries were single fractures, multiple fractures, wounds/cuts/infections, and amputations (in order of incidence). The most common mechanism was the foot slipping off the footplate during wheelchair mobility. Conclusions We observed inherent weaknesses in the MAUDE database reporting process and a concerning level of reporting bias. Although there were limited reports of injuries related to ILED on the footplate during wheelchair mobility, the injuries reported were significant. More standardized reporting of the mechanism and impact of these injuries is needed to better inform wheelchair design, prescription, and patient/family education.

I provide a brief personal introduction including my professional background, interests, and qualifications. I invite authors with a wide diversity of interests to submitted manuscripts to the journal. My overarching goals is to improve the journal’s impact through (1) strategic partnerships with professional organizations and research consortia, (2) publication of targeted Special Collections focused on topics of interest to the field and (3) improved efficiency in manuscript submission and review.

When a wound fails to progress toward healing, it becomes chronic. Chronic wounds occur in all patient populations and cause significant pain and disability for affected individuals. They are also a major economic burden. Unfortunately, wound management is one of the few areas where little reduction in incidence has been seen in recent years, demonstrating that new approaches to prevention remain critically important. This chapter addresses the development and application of smart technologies in primary wound prevention and secondary wound care. Smart wound management technology as a primary prevention tool will make it possible to sense wound formation before clinical appearance, enabling proactive prevention strategies to be implemented. Smart wound care technology will enable concurrent monitoring of wound status and adaptive delivery of wound treatment. The future of wound care will be revolutionized by the application of smart technology to prevent, treat, and monitor chronic wounds.

Objective: To investigate potential linkages between pressure injury (PrI) recurrence following spinal cord injury (SCI) and muscle-based and circulatory biomarkers, specifically fatty metabolites and inflammatory cytokines. Design: Observational study. Setting: Tertiary Care Center. Participants: 30 individuals with complete or incomplete SCI. Study participants either had never developed a PrI (Group I) or had a history of recurrent PrI (Group II). Interventions: Not applicable. Outcome Measures: Gluteal muscle histology, immunohistochemistry, muscle-based and circulatory fatty metabolites and inflammatory cytokines. Results: Gluteal intramuscular adipose tissue (IMAT) was greater than 15% in most Group II (83%) individuals. Muscle tissue histology confirmed intramuscular structural differences. Fatty acid binding protein 4 (FABP4) and fatty acid binding protein 3 (FABP3) were reliably detected in muscle and blood and significantly correlated with IMAT (P

Objective: Nonviable necrotic eschar is an impedance to wound healing and can ultimately lead to failure of soft tissue coverage in traumatic or high-risk wounds. Topical therapeutic agents can provide a less invasive management alternative to surgical debridement of eschar. Approach: The case of a 40-year-old male with a traumatic right lower extremity amputation complicated by surgical incision ischemic eschar formation is reported. Honey-based salve with burdock leaf dressings was used to noninvasively manage eschar extending over the incision site. Images were obtained for 5 months of follow-up. Results: Five-month follow-up demonstrated complete resolution of eschar and re-epithelialization of skin in the affected region. Innovation: Honey-based salve with burdock leaf dressings shows promise for enhancing healing outcomes in traumatic wounds that develop nonviable eschar. Conclusion: Surgical debridement of an amputation stump with large ischemic eschar was avoided with the use of honey-based salve with burdock leaf dressings.

BACKGROUND Pressure ulcers (PU) and deep tissue injuries (DTI), collectively known as pressure injuries are serious complications causing staggering costs and human suffering with over 200 reported risk factors from many domains. Primary pressure injury prevention seeks to prevent the first incidence, while secondary PU/DTI prevention aims to decrease chronic recurrence. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. The correction of all risk factors can be both overwhelming and impractical to implement in clinical practice. There is a need to develop practical clinical tools to prioritize the multiple recommendations of CPG, but there is limited guidance on how to prioritize based on individual cases. Bioinformatics platforms enable data management to support clinical decision support and user-interface development for complex clinical challenges such as pressure injury prevention care planning. OBJECTIVE The central hypothesis of the study is that the individual’s risk factor profile can provide the basis for adaptive, personalized care planning for PU prevention based on CPG prioritization. The study objective is to develop the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury (SCIPUD+) Resource to support personalized care planning for primary and secondary PU/DTI prevention. METHODS The study is employing a retrospective electronic health record (EHR) chart review of over 75 factors known to be relevant for pressure injury risk in individuals with a spinal cord injury (SCI) and routinely recorded in the EHR. We also perform tissue health assessments of a selected sub-group. A systems approach is being used to develop and validate the SCIPUD+ Resource incorporating the many risk factor domains associated with PU/DTI primary and secondary prevention, ranging from the individual’s environment to local tissue health. Our multiscale approach will leverage the strength of bioinformatics applied to an established national EHR system. A comprehensive model is being used to relate the primary outcome of interest (PU/DTI development) with over 75 PU/DTI risk factors using a retrospective chart review of 5000 individuals selected from the study cohort of more than 36,000 persons with SCI. A Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) is being developed to enable robust text-mining for data extraction from free-form notes. RESULTS The results from this study are pending. CONCLUSIONS PU/DTI remains a highly significant source of morbidity for individuals with SCI. Personalized interactive care plans may decrease both initial PU formation and readmission rates for high-risk individuals. The project is using established EHR data to build a comprehensive, structured model of environmental, social and clinical pressure injury risk factors. The comprehensive SCIPUD+ health care tool will be used to relate the primary outcome of interest (pressure injury development) with covariates including environmental, social, clinical, personal and tissue health profiles as well as possible interactions among some of these covariates. The study will result in a validated tool for personalized implementation of CPG recommendations and has great potential to change the standard of care for PrI clinical practice by enabling clinicians to provide personalized application of CPG priorities tailored to the needs of each at-risk individual with SCI. REGISTERED REPORT IDENTIFIER RR1-10.2196/10871

An appropriate wheelchair cushion is integral to pressure ulcer (PU) prevention for the wheelchair user with SCI. For users who find it difficult to remember or perform weight shifts, an alternating pressure air cushion (APAC) may off-load pressure to minimize PU risk. APACs are considered mobility assistive technology (AT). Effective AT delivery includes consideration of the AT consumer as a unique individual. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) is a structured and standardized method to measure user satisfaction with AT.Twelve full time wheelchair users with SCI were provided with an APAC six times for 2 weeks daily home use every 3 months. At the completion of the 18-month study period, the 8-variable QUEST 2.0b questionnaire was applied to evaluate satisfaction with APAC use.Users were generally quite satisfied with APAC weight (p 0.01 relative to neutral). Durability was more likely to be an area of concern. Overall, 92% of participants considered themselves quite satisfied or very satisfied with APAC use (p 0.001).Users with SCI were satisfied with the overall performance of the APAC tested after repeated periods of use. The majority of user's were very satisfied with APAC comfort overall. Implications for Rehabilitation Abandonment of AT may be reduced if user satisfaction is evaluated. The QUEST 2.0b is a useful and valid measure of user satisfaction with alternating pressure air cushions. In the current study cohort, users with SCI were satisfied with the performance and comfort of the APAC tested after repeated periods of use.

Spinal cord injuries (SCI) can disrupt communications between the brain and the body, leading to a loss of control over otherwise intact neuromuscular systems. The use of electrical stimulation (ES) of the central and peripheral nervous system can take advantage of these intact neuromuscular systems to provide therapeutic exercise options, to allow functional restoration, and even to manage or prevent many medical complications following SCI. The use of ES for the restoration of upper extremity, lower extremity and truncal functions can make many activities of daily living a potential reality for individuals with SCI. Restoring bladder and respiratory functions and preventing pressure ulcers may significantly decrease the morbidity and mortality following SCI. Many of the ES devices are already commercially available and should be considered by all SCI clinicians routinely as part of the lifelong rehabilitation care plan for all eligible individuals with SCI.

Objective: In a systematic preclinical investigation of ischemic wound healing, we investigated the hypothesis that electrical stimulation (ES) promotes the healing of ischemic wounds. Approach: The effects of varying clinically relevant ES variables were evaluated using our modified version of the Gould F344 rat ischemic wound model. Stimulation was delivered using the novel lightweight integrated, single-channel, current-controlled modular surface stimulation (MSS) device. Stepwise variation allowed the effects of five different stimulation paradigms within an appropriate current density range to be studied. Within each group, 8–10 animals were treated for 28 days or until the ischemic wounds were healed and 5 animals were treated for 12 days. Eight rats received sham devices. A quantitative multivariable outcomes assessment procedure was used to evaluate the effects of ES. Results: Ischemic wounds treated with a decreased interpulse interval (IPI) had the highest rate of complete wound closure at 3 wee...

Objective: Repeated hospital admissions (RHA) for ongoing pressure ulcer (PU) care remains a significant challenge in the clinical management of the spinal cord injury/disorders (SCI/D) population. The current study investigated the significance of risk factors for PU treatment and RHA. Method: A retrospective chart review of veterans admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) Spinal Cord Injury (SCI) unit for Category III or IV PUs was carried out. A random sample of 105 individuals with SCI/D, evaluated by the Wound Care Team (WCT) from 2006 to 2009 was assessed. Multiple PU development risk factors were extracted from the electronic health record system using standardised data collection forms and entered into the Spinal Cord Injury Pressure Ulcer Database (SCIPUD). Potential associations with RHA were analysed. Results: Twenty variables were initially identified as potentially related to PU development. Descriptive statistics and statistically significant associations between risk factors and RHA were determined. Demographic factors showed no significant association with RHA. Duration of injury, power wheelchair use and sub-optimally managed spasticity (SMS) were significantly associated with higher RHA. Suboptimally managed neurogenic bowel (SMNB) at admission was significantly associated with reduced RHA. Conclusion: Factors previously found to be predictive of initial PU development may not, in fact, be predictive of RHA. Some protective trends were observed, such as polypharmacy and marital status, but these did not reach statistical significance in this preliminary study of admission characteristics, warranting further research. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interests to declare.

A repeated-measures study of 13 adult full-time wheelchair users with spinal cord injury (SCI) was carried out to determine whether alternating-pressure air cushion (APAC) use compared with independent pressure relief (IPR) provides reliable, effective pressure relief for individuals with SCI. Bilateral mean ischial interface pressure (IP), transcutaneous oxygen tension (TcPO2), and unilateral laser Doppler blood flow were evaluated. Blood flow component contributions were determined using short-time Fourier transform (STFT)-based spectral analysis. IPR assessment was carried out at recruitment. Study participants then used an APAC for 2 wk every 3 mo for 18 mo. IPR weight-shifting decreased mean ischial IP (p < 0.05) and increased mean TcPO2 (p < 0.05). All variables rapidly returned to preintervention levels following weight-shifting except for the cardiac component of blood flow. APAC-induced weight-shifting decreased mean ischial IP (p < 0.05). Mean TcPO2 increased and was higher than for IPR. STFT analysis indicated that quiet sitting following APAC-induced weight-shifting produced a higher neurogenic component of blood flow than following IPR (p = 0.02). Thus, IPR positively affects multiple aspects of tissue health but produces transient improvements and must be repeated regularly. APAC activation dynamically and continuously alters IP distribution with more sustained positive tissue health effects.

Some individuals with spinal cord injury (SCI) remain pressure ulcer (PU) free whilst others experience a recurring cycle of tissue breakdown. Detailed analysis of gluteal muscle characteristics may provide insights to local tissue viability variability. The study hypothesis was that SCI individuals have altered muscle composition compared to able-bodied (AB).Ten AB and ten SCI received a supine pelvic CT scan, with contrast.Cross-sectional area (CSA) and overall muscle volume were derived using image analysis. Gluteal muscle tissue type was classified at the S2/S3 sacral vertebrae midpoint, the superior greater trochanters margin (GT) and the inferior ischial tuberosities margin (IT) using the linear transformation Hounsfield Unit scale.SCI gluteal CSA was less than for AB throughout the muscle, with the greatest relative atrophy at the IT (48%). Average AB gluteal volume was nearly double SCI. Eight SCI had over 20% infiltrative adipose tissue, three with over 50%. SCI gluteal CSA and intramuscular fat infiltration were significantly negatively correlated (p 0.05). SCI IT axial slices showed less lean muscle and higher intramuscular fat infiltration than more proximally (p 0.05).SCI gluteal muscle characteristics were indicative of impaired tissue viability. SCI disuse muscle atrophy was anticipated; the analytic approach further indicated that intramuscular atrophy was not uniform. SCI muscle composition showed increased proportions of both low density muscle and adipose tissue. CT scan with contrast is effective for gluteal muscle characterization. This assessment technique may contribute to determination of personalized risk for PU development and other secondary complications.

Objective: To investigate the hypothesis that stereophotogrammetric wound size monitoring shows suitable inter-observer reliability and user acceptance for clinical practice use. Method: Veterans admitted for conservative management of severe pressure ulcers were eligible for inclusion in the study. Three-dimensional (3D) digital wound images were independently captured by two expert and two non-expert nurse-observers using a commercially available stereophotogrammetry system, weekly for 6 weeks. A double-blinded analyst generated 3D wound reconstructions, using software to determine geometry. Clinical opinion of wound progression was provided by an expert physician. Results: Thirteen wounds were assessed with more than 80% of all images being readable. Interclass correlation of 0.9867 (p < 0.0001) was observed. Compared with clinical opinion, 3D wound measurement was sensitive between improving and static wounds for wound perimeter, volume, depth and length. Conclusion: These preliminary findings suggest that 3D wound measurement minimises differences in wound measurement between expert and non-expert observers, suggesting it could be implemented with high reliability in health-care settings where several observers are involved in wound care management. Declaration of interest: This study was funded in part by a grant from the Department of Veterans Affairs VISN10 Research Initiative Program. All study personnel contributed to the paper. AJD's effort was provided in partial fulfilment of the requirements for the MD degree from Case Western Reserve University School of Medicine. The authors declare they have no conflict of interests with regard to the information presented in this paper.

Graft wall pulsation amplitude sensing can provide a measure of functional status, e.g. in hemodialysis access grafts. Current implantable graft monitoring sensors require graft modification and direct bloodstream contact. We propose a new class of piezoresistive flexible pulsation sensors which can be wrapped around the graft to measure wall movement. These sensors must be highly flexible to prevent graft constriction; typical strain sensors are too rigid and the strain sensing range is too limited for this application. We describe a novel additive manufacturing (AM) method for printing polydimethylsiloxane (PDMS) with an internal porous structure, such that material compliance may be tuned anisotropically for a given sensor geometry. Prototype flexible pulsation sensors (FPS) consisting of structured PDMS with an embedded conductive PDMS sensor layer were fabricated and tested. Initial tests demonstrated reliable sensor response to 1-Hz cyclic elongation of 20%, and a sensor gauge factor of 1.0.

In 2005, JBJS published an article by Tongue et al. highlighting the importance of patient-centered care by orthopaedic surgeons1; Tongue et al. noted that understanding the patient’s needs is central to quality care. In the current study, Choido et al. carried out a moderately sized study of their own patients following an undefined range of ankle and foot surgical procedures. Inherent biases can, in part, be gleaned from the title, which indicates a presumption that complete non-weight-bearing is the ideal to be gained. As Bhandari et al. noted over a decade ago, social factors are important determinants of successful outcomes following ankle fracture2. Arnold et al.3 reported that even functional ankle instability has a measureable impact on health-related quality of life. In a Cochrane Review of hip fractures, Crotty et al.4 recommended that core outcomes should include patient-reported factors such as quality of life and …

BackgroundPressure ulcer development is a common, serious complication after spinal cord injury (SCI). Although many biophysical agents are available for treatment, few randomized controlled trials of their efficacy have been done.ObjectiveThe study objective was to examine the efficacy of low-pressure pulsatile lavage treatment for stage III and IV pressure ulcers in people with SCI.DesignThis study was a randomized controlled trial. Participants and assessors were unaware of intervention assignments.SettingThis study was conducted in an SCI tertiary care center inpatient unit.ParticipantsParticipants were 28 people with SCI and stage III and IV pelvic pressure ulcers; 14 participants each were randomly assigned to treatment and control (sham treatment) groups.InterventionDaily low-pressure pulsatile lavage treatment with 1 L of normal saline at 11 psi of pressure was applied to the treatment group along with standard dressing changes. The control group received only sham treatment and standard dressing changes.MeasurementsLinear and volume measurements of pressure ulcer dimensions were obtained weekly for 3 weeks.ResultsStatistical analysis with the t test revealed no statistically significant difference in demographics between groups. Random-coefficient models for analysis of linear and volume measurements revealed improvements over time for both groups. Time trend analysis revealed greater measurement decreases for the treatment group. Differences in rates of change (with 95% confidence intervals) for treatment and control groups, respectively, were: depth, −0.24 (0.09 to −0.58) cm/wk; width, −0.16 (0.06 to −0.39) cm/wk; length, −0.47 (0.18 to −1.12) cm/wk; and volume, −0.33 (0.13 to −0.80) cm3/wk.LimitationsStudy limitations were small sample size and inclusion of only one site. Additionally, participants were not queried about their group assignments.ConclusionsPulsatile lavage enhanced stage III and IV pelvic pressure ulcer healing rates in people with SCI relative to standard pressure ulcer treatment alone.

Introduction: Accurate wound size measurement is vital to assessment of progressive healing. Lack of an accepted “gold standard” is a major obstacle to assessment of any effective wound management regimen. Methodology: Sixteen pelvic region pressure ulcers were monitored weekly for 3 weeks. All wounds were stage III or IV, equally divided between sacral and ischial locations. Linear wound size was measured using the Decubitus Disposable Measuring Guide (DDMG). Wound size index was defined as the sum of the linear dimensions. Wound volume was determined by filling the covered wound cavity with fluid; the volume of saline required to fill the wound was a direct measure of wound volume. Results and Discussion: Correlation between the two measurement methods was determined utilizing Spearman’s rank correlation coefficient. Wound size index decreased significantly (p

Study aim Pressure ulcers (PU) are a common comorbidity among wheelchair users. An appropriate wheelchair cushion is essential to relieve pressure and reduce PU development during sitting. The microenvironment, specifically excessive heat and moisture, impacts risk for PU development. An effective wheelchair cushion should maintain a healthy microenvironment at the seating interface. Measurement of heat and moisture can characterize microenvironmental conditions at the wheelchair cushion interface under load. We describe the development of a Sitting MicroEnvironment Simulator (SMES) for the reliable assessment of wheelchair cushion microenvironments. Materials The prototype SMES was developed for use mounted on a Materials Testing Systems (MTS) 810 ® uniaxial servo-hydraulic loading rig and used to assess microenvironmental conditions for Jay Medical Jay 2 ® , Roho High Profile Dry Floatation ® and Low Profile Dry Floatation ® cushions and a novel modular gel cushion. Methods Each cushion was assessed for two hours in triplicate. The SMES was used to load the cushions to 300N ± 10N, with an interface surface temperature of 37 °C±1 °C and fluid delivery of 13 mL/h±1 mL/h of water. Interface temperature and humidity were measured at the left ischial tuberosity (IT) region every five minutes. Results Heat and moisture responses were similar for the three commercial cushions. The modular gel cushion stayed cooler for at least 15 min longer than any commercial cushion. Conclusions The SMES maintained performance to technical specifications for over one hundred hours of total testing and is a reliable tool for characterizing the microenvironmental conditions of wheelchair cushions.

Haghpanah S, Bogie K, Wang X, Banks PG, Ho CH. Reliability of electronic versus manual wound measurement techniques. Objective To compare the accuracy and reliability of 3 wound measurement techniques, including linear and 2 electronic techniques—Visitrak and the VeV MD system. Design Repeated measures involving forty 2-dimensional "wounds" with a range of clinically relevant sizes were created using regular paper. Blinded observers measured the surface areas of wounds in 2 sessions, using 3 techniques. Setting Research department of a tertiary referral center. Participants Four blinded observers. Interventions Not applicable. Main Outcome Measures Mixed linear models were fitted to determine interobserver and intraobserver variability. The average root mean square error (RMSE) for each measurement technique was determined to investigate the accuracy. Results Intraobserver variation was not significant in most measurement techniques. Interobserver variation was significant for all techniques. Linear measurements showed the highest RMSE, whereas VeV and Visitrak were comparable. Conclusions Reliability of repeated wound measurements for all techniques can be achieved only with the same observer. Linear measurement has the least accuracy in evaluating wound size, VeV is slightly better than Visitrak for large wounds, and Visitrak is slightly better than VeV for small wounds. Our study shows that the use of electronic devices is superior to manual techniques to achieve valid measurements of wound area.

Ideally, all chronic wounds would be prevented as they can become life threatening complications. The concept that a wound produces a ‘current of injury’ due to the discontinuity in the electrical field of intact skin provides the basis for the concept that electrical stimulation (ES) may provide an effective treatment for chronic wounds. The optimal stimulation waveform parameters are unknown, limiting the reliability of achieving a successful clinical therapeutic outcome. In order to gain a more thorough understanding of ES for chronic wound therapy, systematic evaluation using a valid in vivo model is required. The focus of the current paper is development of the flexible modular surface stimulation (MSS) device by our group. This device can be programed to deliver a variety of clinically relevant stimulation paradigms and is essential to facilitate systematic in vivo studies. The MSS version 2.0 for small animal use provides all components of a single-channel, programmable current-controlled ES system within a lightweight, flexible, independently-powered portable device. Benchtop testing and validation indicates that custom electronics and control algorithms support the generation of high-voltage, low duty-cycle current pulses in a power-efficient manner, extending battery life and allowing ES therapy to be delivered for up to 7 days without needing to replace or disturb the wound dressing.

Objective: In a systematic preclinical investigation of ischemic wound healing, we investigated the hypothesis that electrical stimulation (ES) promotes the healing of ischemic wounds.

This paper reviews applications of therapeutic electrical stimulation (ES) specific to wound healing and pressure sore prevention. The application of ES for wound healing has been found to increase the rate of healing by more than 50%. Furthermore, the total number of wounds healed is also increased. However, optimal delivery techniques for ES therapy have not been established to date. A study of stimulation current effects on wound healing in a pig model has shown that direct current (DC) stimulation is most effective in wound area reduction and alternating current (AC) stimulation for wound volume reduction at current densities of 127 microA/cm2 and 1,125 microA/cm2, respectively. Preliminary studies have been carried out at two research centers to assess the role of ES in pressure sore prevention. Surface stimulation studies have shown that ES can produce positive short-term changes in tissue health variables such as regional blood flow and pressure distribution. The use of an implanted stimulation system consisting of intramuscular electrodes with percutaneous leads has been found to produce additional long-term changes. Specifically, gluteal muscle thickness increased by 50% with regular long-term ES application concurrent with a 20% decrease in regional interface pressures and increased tissue oxygen levels. These findings indicate that an implantable ES system may have great potential for pressure sore prevention, particularly for individuals who lack sensation or who are physically unable to perform regular independent pressure relief.

This paper reviews the therapeutic and neuroprosthetic applications of functional neuromuscular stimulation (FNS), also known as functional electrical stimulation (FES), for lower extremity rehabilitation after spinal cord injury and summarizes the important clinical and technical issues involved in its use. The therapeutic effects of electrical stimulation on disuse atrophy, muscle strength and endurance, cardiopulmonary status, and tissue viability in terms of risk of pressure sore development are summarized. Neuroprosthetic uses of surface and implanted technologies for standing, ambulation, and personal mobility are also described. Health and functional benefits, contraindications, and other clinical considerations are discussed, along with the potential of the technology to be an important component in the overall rehabilitation of persons with spinal cord injuries.