Comparing the effects of three different multilayer dressings for pressure ulcer prevention on sacral skin after prolonged loading: An exploratory crossover trial

Abstract

Evidence suggests that preventive dressings applied on sacral skin help to prevent pressure ulcers. However, possible performance differences of different dressing types are unclear. An exploratory randomized crossover trial with intra‐individual comparisons was conducted to compare the effects of three different multi‐layer foam dressings (Mepilex Border Sacrum, ALLEVYN Life Sacrum and Optifoam Gentle Sacrum) compared to no dressing on the sacral skin. Healthy female volunteers (n = 12, mean age 72 years) wore three different dressings on their sacral skin for 3.5 hours while lying supine on a standard hospital mattress. At regular intervals, subjects performed standardized movements to enhance shear loads. Skin surface temperature, stratum corneum hydration, erythema, skin roughness and the interleukin 1 alpha (IL‐1α) concentration per total protein were measured at baseline and after the lying periods. After 3.5 hours, the median skin temperature increased in all four groups between 3.0°C and 3.8°C with only minor differences between the no dressing and the dressing groups. Median stratum corneum hydration increased during the lying period in all groups with highest increases in the Optifoam Gentle Sacrum (7.3 arbitrary units) and no dressing group (7.0 arbitrary units). There was a median decrease of the mean roughness (Rz) in the Optifoam Gentle Sacrum group of −6.3 μm but no relevant changes in the other groups. After loading, the erythema index was highest in the ALLEVYN Life Sacrum and no dressing groups. Highest releases of IL‐1α were observed in the ALLEVYN Life Sacrum and Optifoam Gentle Sacrum groups, in the Mepilex Border Sacrum group changes were minor. Study results indicate, that the application of preventive dressings on sacral skin during loading do not cause additional occlusion compared to loading without dressings when lying supine. Different dressings cause different cutaneous responses during loading.

Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

“…In addition, comparing baseline with post loading values indicates that 2 hours loading on a basic foam mattress leads to an increase of skin temperature, TEWL, SCH, epidermal hydration, and erythema 30 . Similar observations were described previously and indicate that mechanical loading of heel and sacral skin on a basic foam mattress leads to occlusion and to a variety of structural skin and soft tissue changes 9‐11,35,36 …”

“… 30 Similar observations were described previously and indicate that mechanical loading of heel and sacral skin on a basic foam mattress leads to occlusion and to a variety of structural skin and soft tissue changes. 9 , 10 , 11 , 35 , 36 …”

Effects of loading and prophylactic dressings on the sacral and heel skin: An exploratory cross‐over trial

“…There seemed to be an increase of IL-1α after loading at the sacrum. This is supported by a recent study by Wert et al 16 who showed reduced IL-1α releases during mechanical stimulation when wearing a dressing compared with no dressing. Interestingly, median differences between baseline and post-loading at the heels and sacrum were higher in group A compared with group C, indicating a possible protective effect of the dressing during loading.…”

“…For example, Wert et al 15 investigated the inflammatory response of the skin in healthy participants after combined loading of pressure and shear applied on the volar aspect of both forearms in the absence or presence of three foam dressings. Lechner et al 16 suggest that there are differences regarding the cutaneous response between wearing a dressing and no dressing during loading and that there seem to be differences between different dressings. However, neither the heel skin nor the effects of wearing dressings without loading were investigated.…”

“…Wert et al 15 and Lechner et al 16 measured interleukin 1 alpha (IL‐1α) to detect possible inflammatory responses in the skin. IL‐1α is released from keratinocytes in response to mechanical deformation and is considered today as a suitable marker for skin damage because of loading.…”