Soft Tissue Biomechanics in Wound Healing and Prevention

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Background

Wound healing and prevention of chronic wounds are challenging issues in public health. Chronic wounds often result from pressure ulcers/injuries, diabetic foot ulcers, and skin breakdown of the residual limb. Pressure ulcers occur in people with limited mobility, such as people with spinal cord injury and the elderly. Diabetic foot ulcers are the result of complications caused by diabetes, including diabetic neuropathy and peripheral artery disease. Skin breakdown of the residual limb occurs due to repetitive loads transferred from the encapsulating prosthetic socket during physical activities. Unfortunately, even after decades of efforts on the prevention and treatment of these wounds their incidence remains largely unchanged.

Wounds are thought to result from prolonged, repetitive mechanical loads which may be either compressive or shear forces. The current clinical practice emphasizes the decrease of mechanical loads by providing support surfaces (wheelchair cushions, hospital mattresses, novel prosthetic socket materials and designs, and therapeutic insoles) to relieve points of high interface pressure between the device and the soft tissues of the individual. However, interface pressure alone does not fully describe the risk of wound development and thus preventive and treatment interventions based on this principle may not be effective. In addition, current approaches often ignore the detailed biomechanical properties of compressed soft tissues consisting of the skin, subcutaneous tissue, fat, fascia, muscles, and blood vessels that are nonlinear, viscoelastic materials. Different patient populations and different sites of soft tissues have very different structures, properties, and hence stress-strain relationships that respond differently to mechanical loads. Furthermore, the current understanding of soft tissue biomechanics is based primarily on the behavior of ligaments, tendons, and muscles under tension rather than on the mechanics of bulk soft tissue (consisting of skin, subcutaneous tissue, fat, fascia, muscle and blood vessels) under compression.

Theoretically, a single mechanical overload can cause soft tissue damage, while repetitive sub-maximal mechanical loads can trigger adaptation. The adaptive response is known to be rate-dependent and is also affected by the magnitude of the mechanical loads and tissue viability of the individual. Whilst theories to describe soft tissue adaptation and interventions based on these theories have been developed with the aim to enhance the resistance to mechanical loads in ligaments, tendons and muscles, very little research focussed on enhancing soft tissue resistance to compressive loads, especially in patient groups.

The objective of this Research Topic is to bring together researchers from various fields to better understand the role of soft tissue biomechanics to enable a step-change for the prevention and treatment of wounds to occur. Recent developments in imaging and biomedical devices to assess mechanical properties of soft tissues and their micro-climate environment provide an essential basis on which substantial progress beyond the current state of the art seems feasible. In addition, robotic and wearable devices provide an excellent opportunity to sense the risk of wound development for providing timely interventions. Computational and theoretical models could provide new insights on the development of wounds as well as optimization of the current clinical interventions. Assessing micro-vascular networks embedded in the soft tissues can be used to evaluate risk for ischemic injury and wounds. Articles in all topics related to the assessment of soft tissue biomechanical properties and tissue viability and biomechanical based interventions in wound healing and prevention that represent major progress in the area are welcome.

Dr. Matthew Major holds patents on prosthetic use and methods, and Dr. Sharon Sonenblum holds a patent on a wheelchair in-seat activity tracker. All other Topic Editors declare no competing interests with regard to the Research Topic subject.

Keywords: Blood Vessel, Connective Tissue, Constitutive Properties, Nonlinearity, Viscoelasticity

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