{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:59:38Z","timestamp":1789729178697,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,9,27]],"date-time":"2017-09-27T00:00:00Z","timestamp":1506470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The sacral region is the most common site for pressure injuries (<jats:styled-content style=\"fixed-case\">PIs<\/jats:styled-content>) associated with lying in bed, and such sacral <jats:styled-content style=\"fixed-case\">PIs<\/jats:styled-content> often commence as deep tissue injuries (<jats:styled-content style=\"fixed-case\">DTIs<\/jats:styled-content>) that later present as open wounds. In complex patients, diabetes is common. Because, among other factors, diabetes affects connective tissue stiffness properties, making these tissues less able to dissipate mechanical loads through physiological deformations, diabetes is an additional biomechanical risk factor for <jats:styled-content style=\"fixed-case\">PIs<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">DTIs<\/jats:styled-content>. A preventive measure with established successful clinical outcomes is the use of sacral prophylactic dressings. The objective of this study has been to expand our previous work regarding the modes of action and biomechanical efficacy of prophylactic dressings in protecting the soft tissues adjacent to the sacrum by specifically examining the role of a directional stiffness preference (anisotropy) of the dressing while further accounting for diabetic tissue conditions. Multiple three\u2010dimensional anatomically detailed finite element (<jats:styled-content style=\"fixed-case\">FE<\/jats:styled-content>) model variants representing diabetic tissue conditions were used, and tissue loading state data were compared with healthy tissue simulations. We specifically compared soft tissue exposures to elevated internal shear stresses and strain energy densities (<jats:styled-content style=\"fixed-case\">SED<\/jats:styled-content>) near the sacrum during supine weight bearing on a standard (foam) hospital mattress without a dressing, with a prophylactic dressing lacking directional stiffness preferences and with an anisotropic dressing. Our results have clearly shown that an anisotropic dressing design reduces the peak tissue stresses and exposure to sustained tissue deformations in both healthy and diabetic cases. The present study provides additional important insights regarding the optimal structural and material design of prophylactic dressings, which in turn, informs clinicians and decision makers regarding beneficial features.<\/jats:p>","DOI":"10.1111\/iwj.12821","type":"journal-article","created":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T15:48:45Z","timestamp":1506613725000},"page":"1370-1377","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["The contribution of a directional preference of stiffness to the efficacy of prophylactic sacral dressings in protecting healthy and diabetic tissues from pressure injury: computational modelling studies"],"prefix":"10.1111","volume":"14","author":[{"given":"Ayelet","family":"Levy","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dafna","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0223-7218","authenticated-orcid":false,"given":"Amit","family":"Gefen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,27]]},"reference":[{"key":"e_1_2_5_2_1","volume-title":"Prevention and Treatment of Pressure Ulcers: Quick Reference Guide","author":"Haesler E","year":"2014"},{"key":"e_1_2_5_3_1","first-page":"40","article-title":"Results of nine international pressure ulcer prevalence surveys: 1989 to 2005","volume":"54","author":"Van Gilder C","year":"2008","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2006.00684.x"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-014-1031-7"},{"key":"e_1_2_5_6_1","first-page":"432","article-title":"Biomechanical changes in connective tissues induced by experimental diabetes","volume":"98","author":"Andreassen TT","year":"1981","journal-title":"Acta Endocrinol"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00264762"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12101"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2015.24.8.340"},{"key":"e_1_2_5_10_1","first-page":"42","article-title":"Practice recommendations for preventing heel pressure ulcers","volume":"54","author":"Fowler E","year":"2008","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(07)33069-9"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001735.pub4"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2015.01.001"},{"key":"e_1_2_5_14_1","first-page":"42","article-title":"Computer modeling studies to assess whether a prophylactic dressing reduces the risk for deep tissue injury in the heels of supine patients with diabetes","volume":"62","author":"Levy A","year":"2016","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_5_15_1","unstructured":"LevyA GefenA. 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