{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T23:00:35Z","timestamp":1773183635516,"version":"3.50.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T00:00:00Z","timestamp":1646784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objective:<\/jats:title><jats:p>To follow up patients with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A Japanese rehabilitation center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>We included patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (<jats:italic>n<\/jats:italic> = 7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Education on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the patients were seated on the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome Measures<\/jats:title><jats:p>The primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all patients, and the interface pressure could be reduced in 5\/7 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This is the first study to follow up with patients having spinal cord injuries and subdermal low-echoic lesions in the ischial region using ultrasonography. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in patients with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.848338","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T09:41:42Z","timestamp":1646818902000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries"],"prefix":"10.3389","volume":"9","author":[{"given":"Shinji","family":"Kawasaki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihide","family":"Nishimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Kouda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasunori","family":"Umemoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tokio","family":"Kinoshita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takamasa","family":"Hashizaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Kawanishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taro","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiro","family":"Tajima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1097\/WON.0000000000000281","article-title":"Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system","volume":"43","author":"Edsberg","year":"2016","journal-title":"J Wound Ostomy Continence Nurs."},{"key":"B2","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1179\/2045772313Y.0000000093","article-title":"Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends","volume":"36","author":"Kruger","year":"2013","journal-title":"J Spinal Cord Med."},{"key":"B3","first-page":"19","article-title":"Etiology of decubitus ulcers","volume":"42","author":"Kosiak","year":"1961","journal-title":"Arch Phys Med Rehabil."},{"key":"B4","first-page":"623","article-title":"Evaluation of pressure as a factor in the production of ischial ulcers","volume":"39","author":"Kosiak","year":"1958","journal-title":"Arch Phys Med Rehabil."},{"key":"B5","first-page":"492","article-title":"Etiologic factors in pressure sores: An experimental model","volume":"62","author":"Daniel","year":"1981","journal-title":"Arch Phys Med Rehabil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1097\/00006534-198011000-00008","article-title":"Differential response of skin and muscle in the experimental production of pressure sores","volume":"66","author":"Nola","year":"1980","journal-title":"Plast Reconstr Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/00325481.1985.11698993","article-title":"Pressure ulcers. what to do if preventive management fails","volume":"77","author":"DeLisa","year":"1985","journal-title":"Postgrad Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/PRS.0b013e3181addb33","article-title":"Ultrasound assessment of deep tissue injury in pressure ulcers: possible prediction of pressure ulcer progression","volume":"124","author":"Aoi","year":"2009","journal-title":"Plast Reconstr Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1097\/00152192-200603000-00004","article-title":"Issues and challenges in staging of pressure ulcers","volume":"33","author":"Doughty","year":"2006","journal-title":"J Wound Ostomy Continence Nurs."},{"key":"B10","first-page":"34","article-title":"Are all pressure ulcers the result of deep tissue injury? 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