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Printable Handouts
Navigable Slide Index
- Introduction
- Fatal DTI due to placement on a bedpan
- History of deep tissue injury
- Deep tissue injury - definition
- Deep tissue injury description
- Time to develop pressure ulcers
- Pathogenesis: possible inside out pressure ulcer
- Pathogenesis: the role of cell damage
- The role of hypoxia in DTI
- The role of shear
- Possible zones of infarct, ischemia and injury
- Flap ischemia – a possible corrolary
- Necrotic tissue beneath the ischemic flap
- Reperfusion injury: no flow-flow
- Cellular changes with tissue injury
- Reperfusion injury and wound extent
- Epidemiology of pressure ulcers
- DTI incidence
- Natural history of purple pressure ulcers
- Natural history of sDTI in acute care
- Natural history - prospective study (Richbourg)
- Natural history (Sullivan, 2013)
- Natural history (Honaker, 2014)
- Outcomes of DTI
- Diagnosis of DTI
- Diagnosis of DTI with biomarkers (Dan Bader)
- Prevention of DTI
- Implanted electrodes to target paralyzed muscles
- Clinical presentation is unique
- Photograph of 'typical' sDTI
- Time frame between injury and visible presentation
- DTI following 12 hour operation
- DTI in septic patient, unstable for 48 hours
- Unstageable, full thickness ulcer: initial description
- Epidermal loss in black skin
- Differential diagnosis of purple skin
- Distinguish DTI from skin tears
- Distinguish DTI from ecchymosis
- Distinguish DTI from hematoma
- Degloving injury of the leg
- Distinguish DTI from ischemic tissue changes
- Distinguish DTI from venous engorgement
- Distinguish DTI from Kennedy terminal ulcer
- Finding cases of sDTI
- Reporting DTI cases
- Recommended treatment for DTI
- Treating DTI with noncontact ultrasound
- Treating DTI with noncontact ultrasound: results
- Two extremes of Koziak’s pressure time curve
- Conclusion
Topics Covered
- The history of deep tissue injury (DTI)
- Description and definition of deep tissue injuries
- How does a pressure ulcer develop?
- The roles of shear, hypoxia and ischaemia in DTI
- Reperfusion injury in DTI
- Outcomes of DTI
- Diagnosis
- Prevention
- Distinguishing DTI from conditions with similar appearance
- Treatments
Talk Citation
Black, J. (2014, October 7). Deep tissue injury: the state of the science [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 7, 2024, from https://doi.org/10.69645/HARV1605.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Joyce Black has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
A selection of talks on Dermatology
Transcript
Please wait while the transcript is being prepared...
0:04
The patient
you're seeing on the slide
is the poster child for the
concept of deep tissue injury.
This is a patient who was
admitted to the hospital
for an elective
laparoscopic cholecystectomy
and was left on a bedpan for
no one really knows how long.
But obviously, the deep tissue
injury occurred at that time,
because you could see
the remnant, if you will,
the imprint, of the bedpan
up on the upper buttocks
on the left-hand side of the screen.
This patient died of this wound.
It became completely
necrotic, and she
required diverting colostomy,
multiple debridements,
and died of sepsis from the wound.
So what she taught us was that
this problem that we today call
deep tissue injury is actually
a very serious problem
and could lead to fatalities
in pressure ulcers.
0:56
The idea of deep tissue
injury was studied
by the National Pressure
Ulcer Advisory Panel.
Myself and Richard Bennett were
the original two investigators.
And we decided to look at the
history of deep tissue injury.
And so we went back as far
as Dr. Paget's work in 1874.
And we found something interesting.
We found that, even back in 1874,
he described a skin problem that
was purple when it first showed up.
And purple was not in the original
definition of pressure ulcers.
As you well know, it talked
about non-blanchable erythema.
But Dr. Paget saw purple skin.
And he also said that
the deeper tissue
dies, the muscle and the bone.
And when it sloughs, the
place behind is empty.
So it told us, even
back as far as 1874,
that there was another
phenomenon around.
Dr. Groth, during World War
II, created a pressure ulcer
with a pressure plate and muscle.
And due to the rate
of deterioration,
he said they were
malignant by nature.
Dr. Shea talked about
closed pressure ulcers.
They were never described
in the staging systems
that came into play
in the later 1970s.
And of course, we had a
lot of clinical records
to look at in which people
were calling these wounds
"purple" pressure ulcers or
bruises over intact skin.
Some people thought they were
cautery burns when they saw
them coming out of
the operating room.
But in all instances, they evolved
into full-thickness ulcers.