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Repeatability of Metrics of Skin Microvascular Function at Pressure Injury-Prone Sites Using a Direct Pressure and Heating Protocol
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DOI：10.1159/000550214.png)
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Abstract
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Introduction: This study evaluated the repeatability of a heating and pressure protocol using laser Doppler flowmetry to measure the full dynamic range of skin microvascular responses at the sacrum and heel - key sites for pressure injury risk. Methods: Twelve healthy participants (10 male, 2 female; mean age 28 +/- 4 years; stature 1.77 +/- 0.11 m; body mass 72.6 +/- 11.9 kg; body mass index 23 +/- 3 kg/m2) completed sacrum assessments. Eleven participants (9 male, 2 female; mean age 28 +/- 4 years; stature 1.77 +/- 0.57 m; body mass 79.5 +/- 9.8 kg; body mass index 20.4 +/- 4.5 kg/m2) completed heel assessments. Each participant underwent three identical experimental sessions comprising four phases: baseline, local heating, loading, and pressure release. Skin blood flow was measured continuously. Repeatability was assessed using intraclass correlation coefficients (ICC), with an ICC of 0.75 as a minimum threshold for acceptable repeatability. Four methods were tested to identify the pressure at which blood flow ceased: segmental regression, visual analysis of the initial plateau in blood flow, visual analysis of the final cessation of blood flow, and the plateau that corresponds the final-minute mean. Results: The protocol showed good to excellent repeatability for baseline flow, settled flow at 42 degrees C, and post direct-pressure reactive hyperaemia. Maximum combined thermal and reactive hyperaemia demonstrated excellent repeatability at the sacrum (ICC = 0.93) and heel (ICC = 0.91), while the area under the curve showed good repeatability at the sacrum (ICC = 0.81) and excellent at the heel (ICC = 0.90). Segmental regression showed the strongest repeatability (ICC = 0.90 at the sacrum; ICC = 0.84 at the heel). Visual inspection of the initial plateau in blood flow and absolute cessation of blood flow also exceeded the threshold for acceptable repeatability. Conclusion: This study presents a reproducible protocol for assessing pressure-induced microvascular compromise, capturing responses from complete vascular occlusion to peak thermal-pressure hyperaemic vasodilation. Applied at the sacrum and heel, it offers a quantifiable, non-invasive tool to investigate pressure injury risk in vulnerable populations. It also supports future evaluations of support surfaces, offloading strategies, and novel therapeutic interventions to improve tissue pressure tolerance.
Keywords:
Microvascular resilience
Pressure ulcers
Laser Doppler flowmetry
Repeatability
External pressure
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J
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2.3
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