Prone Positioning Precautions in Plastic Surgery

Shermak, Michele A.; Shoo, Brenda A.; Deune, E. Gene

doi:10.1097/01.prs.0000207390.76490.67

Cited by 31 publications

(36 citation statements)

References 28 publications

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“…7 Appropriate supportive padding should be used at bony surfaces where known superficial nerves are known to travel to avoid nerve compression. 20 Neutral positioning is encouraged to avoid impingement and excessive stretch forces on nerves. 7,20 Neuropraxia assessment should be done postoperatively.…”

Section: Recommendationsmentioning

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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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: Recommendationsmentioning

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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“…There are no data to prove its benefit, but many plastic surgeons currently use goggles (Dupaco, Oceanside, CA) and prone pillows (Orthopedic Systems, Union City, CA) to protect the eyes and face from undue pressure in the prone position. 7 …”

Section: Ocular Injurymentioning

confidence: 99%

“…There have been accounts of vertebral artery dissection, thrombus, and stroke after a plastic surgery procedure in the prone position. 7 This devastating complication occurred several days after an uneventful procedure in which the patient's head was laid on its side on a pillow to avoid pressure on the breathing tube. The position caused obstruction of the vertebral artery, dissection with thrombus formation, and eventual embolus causing stroke.…”

Section: Surgical Positionsmentioning

confidence: 99%

“…Eggcrate padding of the arm on standard arm boards with abduction of both the shoulder and elbow at less than 90 degrees allows maximal protection of the nerves. 2,3,7 Following these basic guidelines for the prone position allows plastic surgeons to avoid these neural and vascular complications.…”

Section: Surgical Positionsmentioning

confidence: 99%

“…To avoid this serious complication, surgeons should use standard foam prone pillows that allow stabilization of the neck in the neutral position and direction of the endotracheal tube away from the face to avoid excessive pressure. 7 Finally, attention should also be given to the arm position to avoid stretch or compression injury to the brachial plexus or its branches. Eggcrate padding of the arm on standard arm boards with abduction of both the shoulder and elbow at less than 90 degrees allows maximal protection of the nerves.…”

Section: Surgical Positionsmentioning

confidence: 99%

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Patient Safety in the Operating Room

Ellsworth

Iverson

2006

Seminars in Plastic Surgery

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Maintaining patient safety in the operating room is a major concern of surgeons, hospitals, and surgical facilities. Circumventing preventable complications is essential, and the pressure to avoid these complications during elective cosmetic surgery is especially important. Traditionally, nursing and anesthesia staff have managed patient positioning and most safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementation of patient safety guidelines by the plastic surgeon is of increasing importance.Key aspects of patient safety in the operating room include thoughtful patient positioning, ocular protection, proper handling of electrocautery, and airway management. If performed correctly with attention to certain anatomic landmarks, preoperative positioning of the patient can prevent nerve injury and postoperative joint or muscle pain. In this article we discuss proper patient positioning with attention to protection against nerve palsy. Further, we discuss common patient positions on the operative table and highlight special concerns associated with each position. Other safety issues including prevention of ocular injury and proper management of electrocautery are discussed.Responsibility of postoperative complications ultimately lies with the surgeon. Careful attention to patient safety guidelines is of paramount importance to surgeons, especially during elective cosmetic procedures. Attention to detail in patient positioning, eye protection, and bovie use can help avoid unnecessary perioperative complications and significantly improve the patient's cosmetic surgery experience.

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