{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:26:57Z","timestamp":1786577217939,"version":"build-2736575974"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Plast Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study investigates the protective role of subcutaneous fat in preventing pressure sores, integrating ultrasound and finite element analysis (FEA) to understand the biomechanical mechanisms. It aims to explore the correlation between subcutaneous fat thickness and pressure sore risk as indicated by Braden scale scores.<\/jats:p>\n                  <jats:p>A total of 100 bedridden patients from the Spine Ward and Pulmonary Medicine intensive care unit were enrolled. Subcutaneous fat thickness in the sacral region was measured using ultrasound, and Braden scale scores were recorded. FEA was used to simulate stress and strain distributions in the muscle and fat layers for varying fat thickness. Statistical analysis was performed using analysis of variance, post hoc Tukey test, and Pearson's chi-square test to correlate fat thickness with mechanical parameters.<\/jats:p>\n                  <jats:p>The results demonstrated a significant negative correlation between subcutaneous fat thickness and pressure sore risk. Patients with lower Braden scale scores (higher risk) had thinner subcutaneous fat. FEA models showed that increased fat thickness reduced maximum total deformation, equivalent stress, and shear stress in muscle and bone tissues.<\/jats:p>\n                  <jats:p>Subcutaneous fat plays a crucial protective role in preventing pressure sores by reducing mechanical strain on tissues. This study highlights the potential for using subcutaneous fat thickness measurements as a predictive tool for pressure sore risk and suggests the exploration of fat grafting as a preventive strategy.<\/jats:p>","DOI":"10.1055\/s-0046-1816058","type":"journal-article","created":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T23:30:21Z","timestamp":1771198221000},"page":"202-209","source":"Crossref","is-referenced-by-count":0,"title":["Exploring How Subcutaneous Fat Prevents Pressure Sores: A Study Using Ultrasound and Finite Element Analysis"],"prefix":"10.1055","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7050-5990","authenticated-orcid":false,"given":"Madhubari","family":"Vathulya","sequence":"additional","affiliation":[{"name":"Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"AJ","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Microvascular Surgery, Rajagiri Hospital, Aluva, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayank","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Kandwal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"issue":"02","key":"ref1","first-page":"24","article-title":"Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel consensus conference","volume":"57","author":"J M Black","year":"2011","journal-title":"Ostomy Wound Manage"},{"issue":"02","key":"ref2","first-page":"26","article-title":"A review of deep tissue injury development, detection, and prevention: shear savvy","volume":"59","author":"A Gefen","year":"2013","journal-title":"Ostomy Wound Manage"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/00006199-198707000-00002","article-title":"The Braden scale for predicting pressure sore risk","volume":"36","author":"N Bergstrom","year":"1987","journal-title":"Nurs Res"},{"issue":"09","key":"ref4","first-page":"1099","article-title":"A review of the biomechanics of deep tissue injuries","volume":"35","author":"A Gefen","year":"2013","journal-title":"Med Eng Phys"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"2805","DOI":"10.1007\/s10439-016-1560-3","article-title":"Development and validation of a high anatomical fidelity FE model for the buttock and thigh of a seated individual","volume":"44","author":"R M Al-Dirini","year":"2016","journal-title":"Ann Biomed Eng"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.jmbbm.2014.09.018","article-title":"The evaluation of new multi-material human soft tissue simulants for sports impact surrogates","volume":"41","author":"T Payne","year":"2015","journal-title":"J Mech Behav Biomed Mater"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1080\/1025584031000121034","article-title":"Can loaded interface characteristics influence strain distributions in muscle adjacent to bony prominences?","volume":"6","author":"C W Oomens","year":"2003","journal-title":"Comput Methods Biomech Biomed Engin"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1038\/sc.2015.184","article-title":"Lipofilling (fat grafting) in the secondary prevention of ischial tuberosity and pelvic pressure ulcers","volume":"54","author":"J G Previnaire","year":"2016","journal-title":"Spinal Cord"},{"key":"ref9","first-page":"817283","article-title":"Treatment of early-stage pressure ulcers by using autologous adipose tissue grafts","volume":"2014","author":"G F Marangi","year":"2014","journal-title":"Plast Surg Int"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1089\/wound.2020.1275","article-title":"Adipose tissue in peripheral obesity as an assessment factor for pressure ulcers","volume":"12","author":"M Vathulya","year":"2023","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s10439-014-1202-6","article-title":"Pressure induced deep tissue injury explained","volume":"43","author":"C W Oomens","year":"2015","journal-title":"Ann Biomed Eng"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1152\/japplphysiol.00889.2005","article-title":"Compression-induced deep tissue injury examined with magnetic resonance imaging and histology","volume":"100","author":"A Stekelenburg","year":"2006","journal-title":"J Appl Physiol"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/00129334-200504000-00013","article-title":"Using support surfaces to manage tissue integrity","volume":"18","author":"D M Brienza","year":"2005","journal-title":"Adv Skin Wound Care"},{"key":"ref14","first-page":"19","article-title":"Etiology of decubitus ulcers","volume":"42","author":"M Kosiak","year":"1961","journal-title":"Arch Phys Med Rehabil"},{"issue":"10","key":"ref15","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/j.bjps.2019.06.036","article-title":"Are fasciocutaneous flaps adequate in the reconstruction of grade 3 and 4 sacral sores? A retrospective volumetric study using artec 3D scanner","volume":"72","author":"M Vathulya","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/SAP.0000000000002941","article-title":"A systematic review comparing outcomes of local flap options for reconstruction of pressure sores","volume":"88","author":"M Vathulya","year":"2022","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1053\/apmr.2003.50038","article-title":"The etiology of pressure ulcers: skin deep or muscle bound?","volume":"84","author":"C V Bouten","year":"2003","journal-title":"Arch Phys Med Rehabil"},{"issue":"03","key":"ref18","first-page":"113","article-title":"The relationship between soft tissue stiffness and pressure ulcers","volume":"15","author":"L E Edsberg","year":"2002","journal-title":"Adv Skin Wound Care"}],"container-title":["Indian Journal of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1816058.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T22:35:55Z","timestamp":1786574155000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1816058"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,15]]},"references-count":18,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,8,12]]},"published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0046-1816058","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0970-0358","1998-376X"],"issn-type":[{"value":"0970-0358","type":"print"},{"value":"1998-376X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,15]]}}}