{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T08:47:09Z","timestamp":1773305229039,"version":"3.50.1"},"reference-count":10,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T00:00:00Z","timestamp":1571184000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Advances in Wound Care"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>We review a case of a 22-year-old healthy man who underwent a 5-h maxillofacial surgery while continuously supine with foam pads placed prophylactically over elevated heels. Immediately after surgery, Stage 1 pressure injuries appeared on the left lateral heel and right lateral ankle, despite the absence of local pressure to these areas. Both lesions eventually resolved. Eight months later, a Doppler evaluation was performed of the patient's lower extremities, the peroneal artery and its tributaries were marked, and the intraoperative positioning was simulated to determine if a wedge at the back of the calf could have obstructed blood flow in these vessels. In this position, the feet naturally abducted so that the lateral calcaneal and posterior malleolar arteries became positioned immediately underneath the wedge. We propose a vascular mechanism of pressure injury development, postulating that some heel pressure injuries are not the result of localized pressure but rather angiosomal ischemia, based on the observation that the anatomical pattern of these lesions frequently follow the distribution of a named vessel. We hypothesize that in this case, intraoperative positioning along with permissive hypotension may have occluded arterial or venous flow to the relevant angiosomes, causing an ischemia reperfusion injury to the downstream tissues.<\/jats:p>","DOI":"10.1089\/wound.2018.0905","type":"journal-article","created":{"date-parts":[[2019,7,3]],"date-time":"2019-07-03T10:14:18Z","timestamp":1562148858000},"page":"580-584","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["On the Origin of Intraoperative Pressure Injury: An Angiosomal Theory of Pressure Injury Formation"],"prefix":"10.1177","volume":"8","author":[{"given":"Caroline E.","family":"Fife","sequence":"first","affiliation":[{"name":"Baylor College of Medicine, Houston, Texas."},{"name":"CHI St. Luke's The Woodlands Wound Clinic, The Woodlands, Texas."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efthymios","family":"Gkotsoulias","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Houston, Texas."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,10,16]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Langemo D. Heel Pressure Ulcers: 2014 International Pressure Ulcer Prevention & Treatment guidelines. National Pressure Ulcer Advisory Panel 2014. www.npuap.org\/wp-content\/uploads\/2015\/02\/4.-Preventing-Treating-Heel-Ulcers-D-Langemo.pdf (last accessed March22 2018)."},{"key":"e_1_3_3_3_2","unstructured":"The National Pressure Ulcer Advisory Panel\u2014NPUAP. National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. NPUAP 2016. www.npuap.org\/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury (last accessed March1 2018)."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1538574410376601"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S23471"},{"key":"e_1_3_3_6_2","unstructured":"National Pressure Ulcer Advisory Panel. Deep tissue injury. 2012. www.npuap.org\/wp-content\/uploads\/2012\/01\/DTI-white-Paper.pdf (last accessed March9 2018)."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00389.2011"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2013.12.010"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2008.166298"},{"key":"e_1_3_3_10_2","first-page":"50","article-title":"Pressure ulcer development and vasopressor agents in adult critical care patients: a literature review","volume":"59","author":"Cox J","year":"2013","unstructured":"Cox J. Pressure ulcer development and vasopressor agents in adult critical care patients: a literature review. Ostomy Wound Manage, 2013; 59:50\u201354, 56\u201360.","journal-title":"Ostomy Wound Manage"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2008.11.001"}],"container-title":["Advances in Wound Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/wound.2018.0905","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/wound.2018.0905","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/wound.2018.0905","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T14:17:29Z","timestamp":1773238649000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/wound.2018.0905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,16]]},"references-count":10,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1089\/wound.2018.0905"],"URL":"https:\/\/doi.org\/10.1089\/wound.2018.0905","relation":{},"ISSN":["2162-1918","2162-1934"],"issn-type":[{"value":"2162-1918","type":"print"},{"value":"2162-1934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,16]]}}}