Fighting Back Against a Cell Killer

cell distortion is a cause of pressure ulcers

Back in the days of the traveling circus, one of the most popular attractions was the human contortionist. This master of flexibility and limberness - sometimes called a human pretzel - would twist himself into all types of impossible positions, pulling the body in ways that seemed impossible to the audience.

The contortionist always left the audience in awe of his self-mastery. But what really impressed people was the knowledge that what he was doing was virtually impossible. If anyone in the audience managed to get into some of those positions, their bodies would snap.

The body is not meant to be twisted and pulled in ways that go against nature. The same is true on the level of cell tissue. Cells can also be contorted in ways that cause damage.

When we sit for periods of time or lie in bed for too long, the cellular tissue bearing the weight of our bodies is distorted, much like the body of the contortionist. In that position, it is only a matter of time before it snaps, according to Professor Amit Gefen, an expert in biomedical engineering at Tel Aviv University.

"When you stretch the body, you break the skeleton," he explained. "When you stretch the body of the cell, you break its skeleton (the plasma membrane), and it fails."

The Impact of Deformation

According to Prof. Gefen, the medical profession has made a great deal of effort toward discovering the impact of reduced blood flow and oxygen on cells and tissue. But the issue of deformation has only been seriously studied over the past decade.

The impact of body weight can produce enough pressure on a cell to disrupt the cytoskeleton - the cell's skeleton or its "envelope" which contains everything other than the nucleus. After this membrane is ruptured, it's a short process to cell death.

It's clear that the distortion of the cells is just as much a cell killer as reduced oxygen. Both lead to skin damage, but distortion may be even more dangerous because ischemia - insufficient blood flow to a part of the body - typically takes up to 6-8 hours, while the damage resulting from deformation of the cells can take only minutes to have a significant impact.

"All our research indicates that direct exposure to cell deformation eventually kills the cell AND over time, accumulates to microscopic tissue damage," he said.

Spotting Damage Early is Key

In order to reverse the damage caused by distortion, the dying cells must be identified very early in the process, before they can even be seen. Once the swelling from the cells starts to be visible, it's too late. The damage has been done.

"When cells die, fluid releases into tissues," Prof. Gefen explained. "The volume of fluid expands and eventually, one can identify it by visual inspection." This is the inflammation and edema that results from dead cells.

The time between the start of the swelling and the advanced stage when it can be seen by the naked eye is when the damage to the skin is happening. It is impossible to prevent damage when the swelling has reached that level. At that point, the only option is treatment.

But at the earlier stage, prevention is still possible, at least in terms of the spread and scope of the pressure injury. "When the initial fluid release has begun, you must intervene to prevent further tissue damage!" he continued. "This must take place when it’s still in the microscopic stage."

To do so, a sub-epidermal moisture (SEM) reading can recognize the first flow of fluid. That's the earliest stage of detection, and vital for repairing the damage. With technological advances now allowing detection at such an early stage, it's now possible to apply preventive measures, even when the cells have started to die.

It may not be possible to prevent all of the damage, but being able to intervene in the stage between the first dying cells and the onset of visible swelling could substantially lower the severity of the pressure injury and possibly even lead to reversal of damage.

The Aim is Always Prevention

Although the impact of body weight on cell support has only been the subject of intense scrutiny in recent years, we already know that that it can cause distortion, and ultimately to cell death.

That knowledge has allowed us to take the war on pressure injuries to a new level - to spot damage or even potential damage much earlier than ever possible before. Thanks to technological advances that allow us to detect the symptoms before the damage begins, our ability to detect damage is fundamentally different than the visual assessments nurses and caregivers relied on in the past.

Technology and research are making it possible to make giant advances in the war on pressure injuries. With early detection, it is possible to start treating potential damage before it has an impact on the patient.

The skin damage that proceeded silently and rapidly can now be detected and fought.