A Multilevel Finite Element Approach to Study Pressure Ulcer Aetiology - Multiscale Computer Modeling in Biomechanics and Biomedical Engineering - page 284

A Multilevel Finite Element Approach
to Study Pressure Ulcer Aetiology

Cees W. J. Oomens

Abstract A pressure ulcer is a form of tissue degeneration as a result of sustained
mechanical loading. In the last 3 decades a lot of research has been done to
understand the aetiology of pressure ulcers. It has become clear that the initial
signs of tissue damage are found at the cell scale. That is where the damage
process starts that eventually leads to severe wounds. In order to define damage
thresholds or to understand what cells ''feel'' it is necessary to have information on
the mechanical status of cells at a scale in the order of micrometres. How the
external loading, that is gravitational body forces and reaction forces at supporting
surfaces on patients in a bed or a wheel chair, is transferred to a local mechanical
state within tissues depends on tissue morphology, mechanical properties and other
boundary conditions and requires an analysis at the scale of the order of centi-
metres to a meter. This cannot be done in one single analysis covering the entire
range of scales. This chapter summarizes some work that our group has done in the
last 10 years on multi-scale modelling of soft tissues that was aimed at under-
standing some of the phenomena that play a role in pressure ulcer development.
The work has shown the potential of multi-scale modelling to gain insight in the
very complex interactions at cell level. It was shown that the heterogeneity in
the microstructure has a profound impact on the way cells deform as well as the
mechanical property changes of the cell after they become damaged.

C. W. J. Oomens ( )

Biomedical Engineering Department, Eindhoven University of Technology,
Eindhoven, The Netherlands
e-mail: [e-mail]

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