Click here for the Wounds UK Home Page May 2006

Successful 25th Anniversary Conference for the Tissue Viability Society	Avoiding blame: is deep tissue injury science or a sham? Much has been said and written recently about the existence of deep tissue injury as a component of pressure ulcer aetiology. This term refers to extensive destruction of soft tissue below the skin which may 'erupt' through the skin and become apparent as a severe full-thickness pressure ulcer. This concept is not new and deep tissue necrosis often associated with the presence of shear within deep tissue layers has been discussed at least since the 1940's. So why is the concept of deep tissue injury suddenly becoming fashionable today? It would be excellent if this was the result of a new series of well conducted studies into the detailed pathophysiology of pressure ulcers. However this is not the case and the resurrection of deep tissue injury appears to owe more to regulatory and financial issues in the United States. If an institution is going to be penalized where a 'medical error' occurs and a pressure ulcer develops then there are strong incentives to be able to state with confidence that the wound that has apparently developed following admission was in fact the eruption of a deep tissue injury caused by another care provider! What does this mean in practice? The recent Symposium on Advanced Wounds Care (SAWC) held at the start of May 2006 in San Antonio featured new companies within its exhibition - companies offering techniques such as high-frequency ultrasound that could be used to detect apparent anomalies in soft tissue structure that could (or could not) be deep tissue injuries. Whereas a few years ago a risk assessment score would be documented to indicate an awareness of the potential for pressure ulcer development now ultrasound scans may be debated to see whether pressure ulcer development could be attributed to prior changes in soft tissue density. Prior attempts to use ultrasound as a predictor of future pressure ulcer damage met with initial enthusiasm but ultimate failure (Clark et al 1990, Clark 1996) and it may be that this renewed interest in hunting for tissue changes as markers of deep tissue injury may also be doomed unless certain key conditions are satisfied. Primarily can anyone validate that apparent changes in an ultrasound scan do mark pathological changes in the visualized soft issues that indeed are deep tissue injuries? We also need to know whether these apparent deep tissue injuries resolve or inevitably proceed to full thickness pressure ulcer development. Without validation or an understanding of the natural history of these apparent deep tissue injuries then the current US interest in deep tissue injury will remain a means of avoiding punishment for care providers and will offer little or nothing to the advancement of our knowledge about pressure ulcer development. Black JM, National Pressure Ulcer Advisory Panel. Moving toward consensus on deep tissue injury and pressure ulcer staging. Advances in Skin & Wound Care. 2005. 18(8): 415-6, 418, 420-1. Clark M. The aetiology of superficial sacral pressure sores. In Proceedings of the 6th European Conference on Advances in Wound Management (Eds DL Leaper, GW Cherry, C Dealey). 1996. Amsterdam: Macmillan Press pp167-169. Clark M, Rowland LB, Wood HA, Crow RA. Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound. Journal of Biomedical Engineering. 1989, 11(3): 200-2. Michael Clark Editor	Keeping up to date with pressure area care Recent publications

Successful 25th Anniversary Conference for the Tissue Viability Society Last month the Tissue Viability Society hosted its annual conference at the National Motorcycle Museum in Birmingham. This conference was notable given that 2006 marks the 25th anniversary of the TVS and the conference programme reflected this important milestone in the life of what is probably the longest established wound group worldwide. The event opened with a presentation by Dr James Robertson, one of the early pioneers of the TVS and a past Chair of the Society and Editor of the Journal of Tissue Viability. This session reminded delegates of the past of their Society while the remainder of the programme looked at how the TVS and others could move pressure ulceration higher up the professional, public and political agenda. One clear marker of the growing importance of the Tissue Viability Society was the attendance at the conference by the current Chairs of the European Pressure Ulcer Advisory Panel, the US National Pressure Ulcer Advisory Panel and the European Wound Management Association (EWMA). For many long serving members of the Tissue Viability Society it was excellent to see partnerships between these groups and the TVS emerge - and in 2007 the TVS will be one of the organizations working with EWMA when that organization returns to the UK to host its Annual meeting in Glasgow (May 2-4 2007). Another marker of the development of the TVS was the submission and presentation of free papers from delegates located in mainland Europe and the United States. With a successful conference completed the TVS now look forward to the remainder of its anniversary year culminating in May 2007 with the EWMA conference. Over 2006 and the start of 2007 members of the TVS will be receiving special issues of the Journal of Tissue Viability that when combined will give readers the scientific and clinical chapters from 'Bedsore Biomechanics' a key text on pressure ulceration that has long been out of print but with a content that remains highly relevant today. Join with TVS now to help celebrate our 25th year - visit www.tvs.org.uk for further details on membership. Keep reading for: Keeping up to date with pressure area care Download this newsletter in PDF format Pressure Ulcer References This month's reference list was derived from recent publications cited on the EMBASE database and published in 2005 or 2006. Ito, S., N. Takada, et al. (2006). "Secondary hemophagocytic syndrome in a patient with methicillin-sensitive Staphylococcus aureus bacteremia due to severe decubitus ulcer." Internal Medicine 45(5): 303-307. Lipworth, A. D., E. P. Hyle, et al. (2006). "Limiting the emergence of extended-spectrum beta-lactamase-producing enterobacteriaceae: Influence of patient population characteristics on the response to antimicrobial formulary interventions." Infection Control & Hospital Epidemiology 27(3): 279-286. Bogie, K. M., X. Wang, et al. (2006). "Long-term prevention of pressure ulcers in high-risk patients: A single case study of the use of gluteal neuromuscular electric stimulation." Archives of Physical Medicine & Rehabilitation 87(4): 585-591. Garcia Fernandez, F. P., P. L. Pancorbo Hidalgo, et al. (2006). "Resources for prevention and treatment of pressure ulcers: The situation in Andalusia (Spain). [Spanish]." Gerokomos 17(1): 47-57. Cutting, K. F. and R. J. White (2006). "Criteria for identifying wound infection - Revisited. [Spanish]." Gerokomos 17(1): 39-47. De Laat, E. H., L. Schoonhoven, et al. (2006). "Implementation of a new policy results in a decrease of pressure ulcer frequency." International Journal for Quality in Health Care 18(2): 107-112. Edlich, R. F., K. L. Winters, et al. (2006). "Scientific basis for the selection of absorbent underpads that remain securely attached to underlying bed or chair." Journal of Long Term Effects of Medical Implants 16(1): 29-40. Wong, T. C. and F. K. Ip (2006). "Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores." International Orthopaedics 30(1): 64-67. Imanishi, K., K. Morita, et al. (2006). "Prevention of postoperative pressure ulcers by a polyurethane film patch [7]." Journal of Dermatology 33(3): 236-237. Josvay, J., M. Sashegyi, et al. (2006). "Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores." Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 59(2): 137-141. Jan, Y. K. and D. M. Brienza (2006). "Technology for pressure ulcer prevention." Topics in Spinal Cord Injury Rehabilitation 11(4). Sener, G., G. Sert, et al. (2006). "Pressure ulcer-induced oxidative organ injury is ameliorated by beta-glucan treatment in rats." International Immunopharmacology 6(5): 724-732. Grey, J. E., S. Enoch, et al. (2006). "Pressure ulcers." British Medical Journal 332(7539): 472-475. Stekelenburg, A., C. W. J. Oomens, et al. (2006). "A new MR-compatible loading device to study in vivo muscle damage development in rats due to compressive loading." Medical Engineering & Physics 28(4): 331-338. Sener, G., G. Sert, et al. (2006). "Melatonin protects against pressure ulcer-induced oxidative injury of the skin and remote organs in rats." Journal of Pineal Research 40(3): 280-287. Rudebusch, S. (2005). "Decubitus prevention starts with surgery!. [German]." Journal fur Anasthesie und Intensivbehandlung 12(2).   Download this newsletter in PDF format