In this blog preview of my upcoming WoundCon Fall 2021 presentation, I propose the angiosome concept as a mechanism for “inside-out” pressure injury development.

— Caroline

Most clinicians know that some pressure injuries happen from the inside out because they’ve seen it, and the current explanation may not provide a sufficient understanding of how or why that happens. Pathophysiologic mechanisms of pressure injuries remain unproven, so it is possible that not all pressure injuries are caused by unrelieved LOCAL pressure. Angiosomes (blocks of tissue with their own vascular supply) and their anatomy can explain many, possibly all, deep tissue injuries in stage 4 pressure ulcers, but what’s even maybe more interesting is that the angiosome concept may also explain what stage 1 pressure injuries are. Although the deep tissue injuries in stage 4 pressure injuries get a lot of our clinical attention because they’re debilitating, take a long time to heal and require a lot of resources, for my entire career I’ve been trying to understand what a stage 1 pressure injury really IS. And I think we know now.

One of the things we clinicians spend a lot of time doing, especially during COVID where we’ve had so many very sick people in the intensive care unit, is trying to understand pressure injury prevention, and yet we’re still failing. In some cases, we’re failing miserably, despite decades of focus on this. Although offloading protocols are in place for most patients at risk of developing a pressure injury, deep tissue pressure injuries, often progressing to stage 4, still occur. There is some evidence to suggest that these injuries may be attributable to low mean arterial pressure.

It’s possible that we haven’t had a clear understanding of the mechanism of pressure injuries, and so our interventions haven’t been focused quite the right way. I think that’s why we need everybody paying attention to this issue because the nurses who are at the bedside have information that physicians may not have listened to carefully. And the basic science researchers are going to have to figure out how to reproduce this experimentally and whether the angiosome mechanism has validity.

The Discussion Continues

For further discussion of the angiosome concept in the pathogenesis of pressure injuries, I invite you to attend my upcoming presentation, “Inside-Out” Pressure Injuries: Applying the Angiosome Concept to Pressure Injury Development,” at WoundCon Fall on November, 12th at 2:30 PM Eastern Standard Time. Registration for WoundCon Fall 2021 is open now and is free for health care professionals, who can earn CME credits by attending.

Register for free at: woundcon.com

Additional Materials:

YouTube Playlist: Watch Pressure Injuries Form from the Inside Out!


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