Skin and tissue changes after spinal cord injury-A scoping review.

STUDY DESIGN: Scoping review. OBJECTIVES: Spinal cord injury causes complex and severe changes in affected skin and underlying tissues, increasing the risk of pressure ulcer development and impeding wound healing. This scoping review provides an updated overview on skin and tissue changes after spinal cord injury. Given the complexity and inconsistent evidence of the topic, this review outlines current knowledge and highlights research gaps. METHODS: A comprehensive literature search was conducted in Medline, Embase, Cochrane Library, and SCOPUS databases. Studies written in English addressing skin and tissue changes after spinal cord injury were included, with no restrictions on study type or publication year. Two reviewers independently screened the studies, and eligible articles were organized into the following six subgroups: 1) histopathology, 2) ultrasonography, 3) biomechanical properties, 4) skin perfusion, 5) sebum- and sweat gland excretion, and 6) microbiota. RESULTS: Out of 5387 articles screened, twenty-three met the inclusion criteria. Findings revealed epidermal atrophy characterized by progressive thinning over time, while the dermal layer demonstrated fibrosis and reduced collagen synthesis. Results on skin thickness were inconsistent, though increased tissue stiffness was consistently reported. Skin perfusion was compromised, with diminished reactive hyperemia, impaired vascular autoregulation, and reduced spontaneous skin oxygenation. CONCLUSION: Skin and tissue affected by spinal cord injury exhibit compromised quality with characteristics of aged and injured skin. Consequently, the skin is less able to resist pressure, shear stress, and ischemia. The reviewed literature reveals substantial gaps in knowledge, underscoring the need for further research to improve clinical care and management.