The Third Focus Meeting of the European Pressure Ulcer Advisory Panel (EPUAP) was held in the Charité Medical University in Berlin, Germany April 4–6, 2016. The engaging, revealing discussions and demonstrations of the complexity of the skin, the body’s largest organ, indicated that research in the field is maturing.
Nearly 150 delegates from across the globe heard from leading clinicians, bioengineers, and other scientists about the prevention, diagnosis, and treatment of pressure ulcers (PUs). The information included several innovative topics that only now are beginning to diffuse into the literature, such as medical device-related PUs analyzed from a bioengineering perspective, incontinence-associated dermatitis, and skin care in pediatrics. New laboratory methods, experimental techniques, and computer simulation tools are allowing bioengineers and scientists to begin to measure and understand the properties of the skin and underlying soft tissues. Although we are still in the early days of perfecting and validating these research methodologies and systems, we ultimately will be able to quickly and noninvasively characterize the state of these tissues and their potential for injury. Although promising progress is already being made toward that goal (eg, by collecting and analyzing biomarkers that are released from an inflamed or otherwise damaged skin), we are currently struggling with determining normative databases for biophysical, physiological, and biomechanical skin and soft tissue properties and with finding adequate methods to measure baseline values of these parameters. Once identified, measured, and standardized with accepted tools, the variability of skin and other tissue health parameters will need to be determined, as well as the influence of factors such as age, gender, common diseases, and environmental conditions.
One particularly powerful research tool highlighted at the conference was computer modeling and simulations. The complex challenges of needed research makes the use of computer modeling (eg, finite element modeling; see recent articles in the January and April 2016 issues of Ostomy Wound Management) a critically important research tool. Once the data for skin and other soft tissues has been validated as appropriate and repeatable, it can be used to develop in silico experiments — that is, computer simulations that cost-effectively examine different scenarios in healthy and unhealthy skin (and other tissues), tissue viability, and risk for injury. For instance, in silico experiments facilitate study of how skin is affected by sustained mechanical loads, frictional conditions, moisture, temperature, age, diseases that impact skin properties and function, or multiple factors together. Computer modeling can process and assess the impact of each of these conditions on the others and on the overall health and risk for tissue damage. Most importantly, appropriately developed and verified models can be used to evaluate the efficacy of existing as well as novel interventions, such as support surfaces or their components, dressings, methods of skin closure postsurgery, and interactions with medical devices.
Clearly, computer modeling is an art based on deep knowledge and extensive experience in bioengineering, and models are only accurate and useful once “good data” are available to simulate or base the simulations upon. Computer modeling also requires adequate assumptions and often involves simplifications, requiring considerable experience. That being said, computer modeling is becoming 1 of the 3 fundamental components in PU research (together with clinical research and experimental laboratory research). This indicates the field is maturing and joining the more well-established biomedical and bioengineering research fields (eg, cardiovascular and orthopedics), where significant breakthroughs were made with the aid of computer modeling and simulations. Our industry also is rapidly adapting computer modeling for evaluating the efficacy of PU prevention and treatment technologies, devices, and consumables and working closely with academia to push skin care and PU prevention technologies forward.
The EPUAP 2016 Focus Meeting reflected the state-of-the-science in skin care and PU prevention and treatment and in predicting the risk for skin breakdown. Progress in these areas will facilitate the optimal care and the protection from Pus that patients with fragile skin desperately need.