Suspected Deep Tissue Injuries were described in the National Pressure Ulcer Advisory Panel’s (NPUAP) Staging System in 2007. Since that time, researchers have used histology and animal models to explain the phenomenom of DTI development. Described as tissue deformation in the skeletal muscle caused by pressure and shear, DTI generally leads to full thickness injury. The current scientific understanding overlooks other possible contributing factors that may lead to full thickness ulceration.
Based upon our experience in clinical practice, the accepted definition does not support what is seen in regards to DTI development. In our experience, patients may develop DTI spontaneously, and outside of the RN’s ability to escalate care. Case studies will present the “classic” DTI development and evolution, as compared with case study “outliers”; these patient’s developed sDTI suddenly, after months of intact skin, or during administration of anticoagulants.
The reality that Deep Tissue Injury does not always simply involve the effects of shear and pressure to the muscle layer is seen in our daily practice. Our observations reveal that patient’s with multiple comorbidities may develop ulcerations despite maximum pressure redistribution, shear reduction and preventative interventions. Current scientific models for DTI are based upon healthy animal subjects or tissue constructs which don’t take into account risk factors for tissue damage such as sepsis, coagulopathy, increased capillary permeability, and the myriad of comorbid conditions found within our population.
Our initial observations will serve as the catalyst for an upcoming research study which will involve the tracking of all sDTI’s in our 800 bed, Trauma Level 1, Academic University Medical Center. The authors will attempt to identify a common “recipe” for DTI development in the Acute Care Setting.