Morphological characteristics of skin of the posterior heel in terms of pressure ulcer development

2007 Fiscal Year Final Research Report Summary

• Project/Area Number: 18592339
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Fundamental nursing
• Research Institution: Kumamoto Health Science University
• Principal Investigator: HAGISAWA Satsue Kumamoto Health Science University, Faculty of Health Science, Professor (90040071)
• Co-Investigator(Kenkyū-buntansha): SHIMADA Tatsuo Oita University, School of Medicine, Professor (80080555) ; ARAO Hiromi Oita University, School of Medicine, Research Associate (00274746)
• Project Period (FY): 2006 – 2007
• Keywords: Pressure ulcer development / Morphological Characteristics / Posterior Heel / Skin

Research Abstract

Posterior heel is known as secondly vulnerable site to pressure ulcer development, however, it remains unclear why it is so. This study was undertaken to identify the morphological characteristics of skin of the posterior heel in terms of pressure ulcer development. Human skin tissues were obtained from four different sites of the body of 4 subjects post mortem: posterior heel and sacrum as vulnerable sites, center of gluteus maximus and heel as non-vulnerable sites. The skin samples were processed for the examination of light microscopy and scanning electron microscopy. It was found that the morphological characteristics of the skin of posterior heel were similar to those of the bottom of the heel, while being different from the sacrum and gluteus maximus. The characteristics of the posterior heel indicated bigger diameter of capillaries in the papillary layer, 3-D-like collagen fibers meshwork in the reticular layer and taller subcutaneous adipose tissues being surrounded by thick collagen and elastic fibers comparing to sacrum and gluteus maximus sites. These were greatly different from those of the sacrum site where is widely known as most vulnerable site. It might be due to less tolerant to the ischemia when excessive pressures including shear force are applied to the limited area of the posterior heel leading to tissue insults subsequently since bigger diameter capillaries with slower flow of the papillae may easily be collapsed with external pressure. At this moment we could not reach definitive conclusion why the posterior heel is predisposing to pressure ulcer development. Further analysis is needed to clarify.