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Skin Integrity and Pressure Injuries

Miscellaneous Physical Treatments

Although pressure redistribution to reduce ischemia is the primary method for pressure injury prevention and management, it is also understood that decreased skin temperature leads to reduced tissue metabolic demand that might translate to reduced reactive hyperemia post-ischemia. To test this theory, Tzen et al. (2013) compared the effects of controlled local cooling on reactive hyperemia resulting from pressure induced ischemia for people with and without SCI.

Author Year
Research Design
Sample Size



Tzen et al. 2013
Prospective Controlled
Population: Mean age: 35.79 yr; Gender: males=20, females= 8; Level of injury (ASIA): grade A or B=14, control group=14.
Intervention: All subjects were tested under three conditions: pressure with fast cooling (-4 degrees Celsius/min), pressure with slow cooling (-33 degrees Celsius) and pressure with no cooling.
Outcome Measures: Reactive hyperemia and its spectral densities in the metabolic, neurogenic, and myogenic frequency ranges.
1. Reactive hyperemia was greater in pressure only when compared to the cooling conditions in the control group.
2. No change in spectral densities for both cooling conditions in SCI or control group.
3. Neurogenic spectral density increased without cooling for control group.
4. In SCI patients, no difference was noted in reactive hyperemia in any conditions.
5. Metabolic and myogenic spectral densities increased without cooling and all spectral densities increased with slow cooling for the SCI group.
6. No change in all spectral densities with fast cooling.


Tzen et al. (2013) were able to confirm that microclimate control was an effective pressure injury prevention strategy in at-risk individuals without SCI; unfortunately, this was not the case for individuals with neurologically compromised vasoconstriction and capillary smooth muscle contraction as in people with SCI.


There is level 2 evidence (from one prospective controlled trial: Tzen et al. 2013) that localized cooling is not a viable pressure injury prevention strategy that is effective for individuals with SCI. Conversely, with neurological control of vasoconstriction and capillary smooth muscle contraction, those without SCI may benefit from microclimate controlled surfaces as a pressure injury prevention strategy.

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