Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries

Shinji Kawasaki; Yukihide Nishimura; Ken Kouda; Yasunori Umemoto; Tokio Kinoshita; Takamasa Hashizaki; Makoto Kawanishi; Taro Nakamura; Fumihiro Tajima

doi:10.3389/fmed.2022.848338

Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries

Front Med (Lausanne). 2022 Mar 9:9:848338. doi: 10.3389/fmed.2022.848338. eCollection 2022.

Authors

Shinji Kawasaki^{1

2}, Yukihide Nishimura³, Ken Kouda¹, Yasunori Umemoto¹, Tokio Kinoshita^{1

2}, Takamasa Hashizaki^{1

2}, Makoto Kawanishi^{1

2}, Taro Nakamura⁴, Fumihiro Tajima¹

Affiliations

¹ Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.
² Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan.
³ Department of Rehabilitation Medicine, Iwate Medical University, Iwate, Japan.
⁴ Department of Rehabilitation Medicine, Oita Nakamura Hospital, Oita, Japan.

Abstract

Objective: To follow up patients with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year.

Design: A retrospective cohort study.

Setting: A Japanese rehabilitation center.

Participants: We included patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (n = 7).

Interventions: Education on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the patients were seated on the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system.

Outcome measures: The primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions.

Results: Of the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all patients, and the interface pressure could be reduced in 5/7 patients.

Conclusions: This is the first study to follow up with patients having spinal cord injuries and subdermal low-echoic lesions in the ischial region using ultrasonography. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in patients with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.

Keywords: interface pressure; pressure injury; sitting time; spinal cord; ultrasonography.