Prognostic models for clinical outcomes in patients with venous leg ulcers: A systematic review.

OBJECTIVE: The purpose of this review was to identify prognostic models for clinical application in patients with venous leg ulcers (VLUs). METHODS: Literature searches were conducted in Embase, Medline, Cochrane, and CINAHL databases from inception to December 22, 2021. Eligible studies reported prognostic models aimed at developing, validating, and adjusting multivariable prognostic models that include multiple prognostic factors combined, and that predicted clinical outcomes. Methodological quality was assessed using the CHARMS checklist and PROBAST short form questionnaire. RESULTS: Thirteen studies were identified, of which three were validation studies of previously published models, four reported derivation and validation of models, and the remainder reported derivation models only. There was substantial heterogeneity in the model characteristics, including 11 studies focused on wound healing outcomes reporting 91 different predictors. Three studies shared similar predicted outcomes, follow-up timepoint and used a Cox proportional hazards model. However, these models reported different predictor selection methods and different predictors and it was therefore not feasible to summarize performance, such as discriminative ability. CONCLUSIONS: There are no standout risk prediction models in the literature with promising clinical application for patients with VLUs. Future research should focus on developing and validating high-performing models in wider VLU populations.

Structural Elements of the Biomechanical System of Soft Tissue.

In living organisms, forces are constantly generated and transmitted throughout tissue. Such forces are generated through interaction with the environment and as a result of the body's endogenous movement. If these internally or externally originating forces exceed the ability of tissues to cope with the applied forces, (i.e. "tissue thresholds"), they will cause force-related tissue harm. However, biotensegrity systems act to prevent these forces from causing structural damage to cells and tissues. The mechanism and structure of soft tissues that enable them to maintain their integrity and prevent damage under constantly changing forces is still not fully understood. The current anatomical and physical knowledge is insufficient to assess and predict how, why, where, and when to expect force-related tissue harm. When including the concept of tensegrity and the related principles of the hierarchical organisation of the elements of the subcellular tensional homeostatic structure into current biomechanical concepts, it increases our understanding of the events in force handling in relation to the onset of force-related tissue harm: Reducing incident forces in tissue to a level that is not harmful to the involved structures is achieved by dissipation, transduction and transferring the force in multiple dimensions. To enable this, the biomechanical systems must function in a continuous and consistent way from the cellular level to the entire body to prevent local peak forces from causing harm. In this article, we explore the biomechanical system with a focus on biotensegrity concepts across several organisational levels, describing in detail how it may function and reflecting on how this might be applied to patient management.