Improving the effect of shear on skin viability with wound dressings

Background: Pressure ulcers are a major healthcare problem and caused by pressure and shear-forces. Although shear-force is understood to be a major contributing factor, no preventive interventions are specifically aimed at relieving the effect of shear on skin to improve skin viability. Methods: A physical model was used to apply a combined loading of 2.4 kPa pressure and 14.5 N shear-force on skin in humans. Loading was applied on the volar aspect of both forearms for 30 min in ten healthy volunteers. One arm received loading on skin with a wound dressing, the other arm (control) received loading directly on skin. The following parameters were determined before and after loading: IL-1 alpha/Total Protein-ratio (used as a measure of skin damage); Cutaneous blood cell flux ((CBF) measure of reactive hyperaemia); Lactate concentration (measure of tissue ischemia). Three different dressings were tested on three different days. The order of dressing application, dressing arm and start of the intervention were randomized. Results: Participants mean age was 22.5 +/- 1.6 year with a BMI of 22.3 +/- 2.4 kg/m(2). IL-1 alpha/Total Protein-ratio of the skin was significantly lower after the application of pressure and shear when the Mepilex (R) (P