Keynote: Revolutionizing the Understanding of Pressure Ulcers: Why Biomedical Engineering has Made the Critical Difference

Pressure ulcers (PUs) are a frequent complication of being insensate or immobile and often lead to devastating consequences such as sepsis, life-endangering infections, kidney and organ failure or loss of limbs. In a continuously ageing population, where chronic diseases spread epidemically, the social and economic impact of PUs grow exponentially. For multiple historical reasons PUs were neglected by mainstream medical and bioengineering research despite being deadly, and even though the literature reports for years that this is a frequent condition not just in the elderly and in persons at the terminal phase of their lives. On the contrary, PUs are common across all care facilities and at all ages including neonatal and pediatric intensive care patients, young individuals with neuromuscular diseases or a central nervous system injury and women treated with epidural anesthesia prior to delivery, to mention a few.

Our research work over the past twenty years has been focused on first understanding the etiology of PUs using an integrated empirical-theoretical approach. Those span in silico, in vitro and in vivo work using cell culture, tissue engineering, animal and computer models as well as human studies and clinical trials. Our work has revealed the mechanisms of PU onset and development. We found that PUs are the result of exposure to sustained cell and tissue deformations which inflict the massive tissue damage presented as PUs. At the time, this had challenged conventional thinking that PUs are caused by ischemic episodes, and our revolutionary concept of tissue deformations as the primary cell killer is now the accepted etiology. With this new understanding of the etiology, we were at last able to conduct methodological bioengineering evaluations of existing successful or unsuccessful clinical interventions and medical devices, to reveal their modes of action. Apparently, the ineffectiveness of some approaches was due to their erroneous focus on ischemia as the major cause of PUs. Now, after mapping the gaps in existing technology, we are translating two decades of intense research into groundbreaking technologies for prevention of PUs.