Please use this identifier to cite or link to this item: https://doi.org/10.1098/rsif.2021.0631
Title: The panniculus carnosus muscle: a missing link in the chronicity of heel pressure ulcers?
Authors: Nasir, N Jannah M
Corrias, Alberto 
Heemskerk, Hans
Ang, Eng Tat 
Jenkins, Julia H
Sebastin, SJ 
Tucker-Kellogg, Lisa 
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
chronic wounds
pressure injuries
functional anatomy of heel
lineage tracing in mouse
biomechanics of muscle
muscle regeneration
EVIDENCE-BASED MEDICINE
SKIN
MODEL
PREVALENCE
ANATOMY
RISK
CARE
Issue Date: 23-Feb-2022
Publisher: ROYAL SOC
Citation: Nasir, N Jannah M, Corrias, Alberto, Heemskerk, Hans, Ang, Eng Tat, Jenkins, Julia H, Sebastin, SJ, Tucker-Kellogg, Lisa (2022-02-23). The panniculus carnosus muscle: a missing link in the chronicity of heel pressure ulcers?. JOURNAL OF THE ROYAL SOCIETY INTERFACE 19 (187). ScholarBank@NUS Repository. https://doi.org/10.1098/rsif.2021.0631
Abstract: Chronic and recurring pressure ulcers (PUs) create an unmet need for predictive biomarkers. In this work, we examine the panniculus carnosus, a thin cutaneous muscle, traditionally considered vestigial in humans, and ask whether the panniculus may play a role in the chronicity and reinjury of heel PUs. To determine whether humans have a panniculus muscle layer at the heel, we dissected eight cadavers. To assess the influence of the panniculus layer on PU, we performed computational simulations of supine weight bearing. Finally, we assessed panniculus regeneration in fluorescent mice. Results show a panniculus layer present in all cadavers examined. Simulations show a thin layer of panniculus muscle causes a dramatic decrease in the volume of soft tissue experiencing high strain and stress, compared to a heel without a panniculus. Importantly, in the mouse model, the panniculus fails to regenerate after PU, even when other cutaneous layers had fully regenerated. Our work shows that the panniculus is able to redistribute load around the heel bone, which might allow it to prevent PUs. Moreover, it is highly susceptible to incomplete regeneration after PU. Poor panniculus regeneration after PU might be a predictive anatomical biomarker for recurrence, and this biomarker should be evaluated prospectively in future clinical trials.
Source Title: JOURNAL OF THE ROYAL SOCIETY INTERFACE
URI: https://scholarbank.nus.edu.sg/handle/10635/219279
ISSN: 17425689
17425662
DOI: 10.1098/rsif.2021.0631
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