Histological examination of pressure ulcer tissue in terminally ill cancer patients

Abstract

Aim: It is a common belief that terminally ill cancer patients have a reduced tissue tolerance that makes them more susceptible than other patients to developing pressure ulcers. However, the actual changes at the tissue level caused by pressure loading in terminally ill cancer patients are unknown, so we examined the relationship between the macroscopic and microscopic features of the tissues of such patients with and without pressure ulcers.Methods: The pressure ulcers of four patients were macroscopically evaluated until the time of death, after which informed consent of the family was obtained to examine the underlying skin tissue histologically. Samples were taken from several sites on the abdomen, which does not experience pressure loading, and from the sacral area. Two of the subjects had no observable pressure ulcers and the other two had a stage I and stage II (National Pressure Ulcer Advisory Panel classification) pressure ulcer, respectively. The samples were processed, stained and examined by using light and transmission electron microscopy.Results: The non-pressure ulcer samples showed degenerated keratinocytes, leakage of erythrocytes from the capillaries in the dermal papillae, vascular inflammation, and edema. The samples from the stage I and II ulcers had the additional changes of dilated capillaries and vascular inflammation in and around the wound area.Conclusion: Terminally ill cancer patients have damaged skin tissue and inflammation that are not evident by macroscopic examination.