Biomechanics and Modeling in Mechanobiology

, Volume 18, Issue 6, pp 1847–1866 | Cite as

A novel ischemia reperfusion injury hereditary tissue model for pressure ulcers progression

  • Elad Bullkich
  • Eitan Kimmel
  • Saar GolanEmail author
Original Paper


Ischemia reperfusion injury (IRI) involvement in pressure ulcers (PU) progression via a surge of oxidative stress and inflammatory responses is well documented. IRI strongly depends on the mechanical loading history. We present a generalized IRI model considering external loading, dynamic tissue healing capacity, accumulating mechanical and reperfusion-mediated damages and competing repair processes of saturating nature. Reperfusion depends on strain and strain rate to enhance loading history sensitivity. Tissue-specific ulceration susceptibility is assumed dependent on variable accumulated damage. We study damage evolution under cyclic loading having several strain expulsion profiles and demonstrate load relief history has critical impact on PU progression. Abrupt load removal generally follows existing models representing extreme repair/damage. We show (first time in silico) that under certain conditions (previously experimentally identified), IRI becomes repairing rather than damaging. In particular, we recapitulate the preconditioning and postconditioning IRI hallmarks. Finally, it is customary among physicians and nurses to promptly alleviate mechanical load applied to patients lying in bed for extended periods and in risk of developing PUs. We demonstrate this practice can be harmful. If load removal is performed early while reperfusion is still beneficial, then this conduct is suitable. However, if critical tissue damage has been crossed, then abrupt expulsion can constitute the worst-case scenario for patient outcome. If no preliminary patient documentation is available, we recommend gradual load removal since risks of accelerated damage eventually leading to ulceration supersede the improved repair potential benefit.


Ischemia Reperfusion Injury Pressure ulcers 


Author contributions

Saar Golan conceived the research, Elad Bullkich gathered the anatomical and physiological data, Elad Bullkich and Saar Golan established the model and Elad Bullkich performed the calculations; all analyzed the data and interpreted the results. Saar Golan drafted the manuscript. All revised and approved the manuscript final version. Saar Golan answered the reviewers’ comments.

Compliance with ethical standards

Conflict of interest

The authors declare that no conflict of interest exists with relation to the contents of this manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Biomedical EngineeringTechnion – Israel Institute of TechnologyHaifaIsrael
  2. 2.Bio-Analytical Microsystems Lab, Department of Chemical EngineeringAriel UniversityArielIsrael
  3. 3.Department of Mechanical EngineeringAriel UniversityArielIsrael

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