Missing links in pressure ulcer research--an interdisciplinary overview.

This paper surveys the literature on the etiology of sitting-acquired deep tissue pressure ulcers from three different viewpoints. The first viewpoint is identification of risk factors related to seated posture. The second viewpoint focuses on the external factors that can cause necrosis to human cells, such as ischemia and compression. The third viewpoint focuses on computational models of the human buttocks to calculate where stress concentrations occur. Each viewpoint contributes to the understanding of pressure ulcer etiology, but in combination they cover the multiple scales from cell to organism, and the combined insight can provide important information toward a full understanding of the phenomenon. It is concluded that the following three questions must be answered by future research. 1) Does compressive stress alone explain cell death, or is it necessary to consider the full three-dimensional strain tensor in the tissues? 2) How does the change in posture-induced load applied on the human buttocks change the stress distribution in the deep muscle tissue? 3) Is it possible to optimize the seated posture in a computational model to reduce the deeper tissue loads?