Rodriguez & Garber 1994;
USA
Downs & Black = 15
Longitudinal
N = 62

Population: All males; with at least 1 past Stage II pressure ulcer; age range 22 – 49 yrs; YPI < 1 yr.
Methodology: Monitored changes in skin metabolism for 2 years in relation to pressure ulcer symptoms
Outcome Measures: 24hr urine sample every 4-6 weeks used to determine concentrations of glu-gal Hyl, gal Hyl, calcium, and creatinine

1. Subjects with sustained elevated concentration of glu-gal Hyl (more than 100 μmole/g creatinine) were significantly more likely to develop pressure ulcers.
2. More smokers than non-smokers developed ulcers.
3. The majority of persons who developed ulcers had injuries of T6 and above.

Park et al. 2011;

South Korea

Downs & Black = 12

Cross-sectional with AB controls

N SCI = 48

N control = 48

Population: 48 males with SCI with C4 or below; 48 age-matched AB controls, divided into 4 groups: Subgroup 1 – complete somatic SCI patients with sympathetic paralysis; Subgroup 1a - incomplete somatic SCI patients with sympathetic paralysis; Subgroup 2 – SCI patients with any AIS whose sensory NLI were low enough to preserve normal sympathetic integrity of the measured dermatomes; Subgroup 3 – healthy controls for each anatomical group. For each of the subgroups there was a shoulder group (SG) and thigh group (TG)

Methodology: Comparison of biomechanical skin properties using a Cutometer MPA 580 (Courage & Khazaka Electronic GmbH) at 2 body regions of the non-dominant side: the anterior shoulder (C4 sensory dermatome) and the middle of the midial thigh (L2 sensory dermatome)

Outcome Measures: skin distensibility; skin elasticity; and skin viso elasticity.

1. In each anatomical group, sympathetic paralyzed subgroups regardless of somatic sensory completeness showed lower value of skin distensibility, and higher values of elasticity and viscoelasticity compared to other subgroups.
2. Age and YPI had significant impact on the biomechanical skin properties.

Vaziri et al. 1992;
USA
Downs & Black = 11
Longitudinal
N = 31

Population: 10 males with SCI and pressure ulcers and 10 males with SCI and without pressure ulcers; mean age 53 + 13 (25 – 79 yrs); 32 AB controls
Methodology: Examined the concentration of plasma fibronectin and its related proteins and its relationship to the healing of pressure ulcers
Outcome Measures: Concentration of plasma fibronectin, fibrinogen, plasminogen, α2antiplasmin and Factor XIII, measured using immunoelectrodiffusion.

1. 10 of the 21 participants in the study group showed near complete healing of pressure ulcer within five weeks; these individuals were classified as fast healers, and the other 11 as poor healers.
2. Plasma fibronectin concentration was ↑ in the fast healers, compared to the slow healers, the SCI control, and the AB control
3. There is a significant correlation between plasma fibronectin concentration and the severity of pressure ulcers in the study group.

Rodriguez & Claus-Walker 1984;
USA
Downs & Black = 8
Cross-sectional with AB controls
N SCI =10
N controls = 5

Population: All males with SCI; age range 14 – 50 yrs; time post-injury < 6 mos.; age and gender matched AB controls
Methodology: Comparison of skin degradation
Outcome Measures: Glu-gal Hyl and gal Hyl from urine samples

1. Although not statistically significant, the concentration of Glu-gal Hyl and gal Hyl were consistent, whereas the group with SCI had a very wide range of values.