Face Tissue Pressure in Prone Positioning

Grisell, Margaret; Place, Howard M.

doi:10.1097/brs.0b013e31818b9029

Cited by 39 publications

(8 citation statements)

References 6 publications

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“…3,21 The risk increases with longer duration and increased volume replacement causing increased facial edema. 21 Pressure on the face in prone position is on average 30 mmHg, but can be higher than 50 mmHg in certain areas such as the chin and forehead above the supraorbital ridge.…”

Section: Head and Neck Pressure Soresmentioning

confidence: 99%

“…The rate of this complication is estimated to be between 0.05% and 1%. 3,21,22,31 Ischemic optic neuropathy (ION) and orbital compartment syndrome (OCS) Direct pressure on orbits can cause trauma resulting in conjunctival edema, hemorrhage, chemosis, pain, and vision loss. 7,14 ION is caused by damage to optic nerve by increased intraocular pressure and orbital venous pressure.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

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The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

207

162

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Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.

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Section: Head and Neck Pressure Soresmentioning

confidence: 99%

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

207

162

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“…Grisell and Place compared the amount of facial pressure on each of the three types of face positioners: the OSI foam positioner (the one used in our patients), Protective Helmet system that uses a disposable polyurethane foam head positioner (Dupaco Inc., Oceanside, CA, USA), and a neoprene air-filled bladder “dry floatation” device by ROHO (The ROHO Group, Belleville, IL, USA). [ 7 ] They observed that tissue pressures seemed equal within the first 15 min and then remained fairly constant. The pressures measured for the Dupaco positioner were lowest at all time points for both the forehead and the chin in comparison to the other two positioners.…”

Section: Discussionmentioning

confidence: 99%

“…These injuries, though seem trivial in nature most of the time, can act as a nidus for infection requiring protracted hospital stay or even surgical intervention occasionally, ultimately leading to increased morbidity and health-care cost. [ 7 ] The nonmonetary costs related to these skin breakdowns include pain, infection, consumption of additional hospital resources, and emotional and physical effects on patients and their caregivers. [ 8 9 ] Reported rates of pressure-related skin ulcers from prone position surgery vary from 5% to 66%.…”

Section: Introductionmentioning

confidence: 99%

Incidence of pressure-related skin injuries in patients operated for spine surgery in prone: A retrospective analysis of 307 patients

et al. 2020

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Background: Spine surgery in prone position frequently results in pressure skin lesions (PSLs). No study from Arabic world has published their incidence in literature. Methods: We retrospectively analyzed patients who underwent prone position spine surgery from December 1, 2017, to November 30, 2018. They received standardized anesthesia care and were made prone on Jackson table. The face was supported on a nonface contoured foam device, whereas the chest and pelvis were supported on soft cushions. Following completion of surgery, they were turned supine and their skin was inspected for any skin lesions. The lesions were categorized into five grades depending on severity. Results: Data of 307 patients were analyzed. Their mean age and weight was 41.5 years and 71 kg, respectively. The mean duration of prone positioning was 470 min. One hundred and three PSLs were observed in 45 patients (14.7%), giving a PSL incidence of 43.7% in affected patients. Majority of patients (18, 40%) with lesions remained in prone position between 421 and 600 min. Multiple lesions were observed in 53.3% of the affected patients. The highest number of patients (21, 46.7%) had one lesion only and it was restricted to face. All lesions were of Grade I, II, or III. Body weight >71 kg was more prone to developing PSLs. Females were more prone to PSLs. Conclusion: PSLs in prone position spine surgery occur frequently, and their incidence is proportional to the duration of positioning and weight of the patients. Face is the most commonly affected area.

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“…A study of facial tissue pressures in the prone position revealed that pressure effects can be reduced by careful selection of an appropriate head rest, with a polyurethane foam head rest within a protected helmet system advocated [13]. Möllmann and colleagueshave advocated for a transparent operating table with a foam-cushion face mask to facilitate intraoperative monitoring [14].…”

Section: Discussionmentioning

confidence: 99%

Chin Necrosis as a Consequence of Prone Positioning in the Intensive Care Unit

Bunker

Thomson

2015

Case Reports in Medicine

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Pressure necrosis of the skin is a rarely reported avoidable complication of prone positioning that can be minimised by active collaboration between care teams. We report a case of pressure necrosis of the chin after prone ventilation in the intensive care setting. Such injuries pose a risk of infection, possible need for surgical intervention, and increased costs to the health care system. Pressure necrosis injuries should be diligently guarded against by the careful selection of support devices, frequent turning, and rigorous skin care to minimise extended external compression, particularly on the face and bony prominences.

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Face Tissue Pressure in Prone Positioning

Abstract: The Dupaco ProneView Protective Helmet System is superior to both the OSI and the ROHO positioners in decreasing forehead and chin tissue interface pressures during prone position surgery.

Cited by 39 publications

References 6 publications

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Incidence of pressure-related skin injuries in patients operated for spine surgery in prone: A retrospective analysis of 307 patients

Chin Necrosis as a Consequence of Prone Positioning in the Intensive Care Unit

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