Abstract：

The development of pressure ulcers is a persistent problem,and global efforts to prevent pressure ulcers have been enacted.incidence of intraoperatively acquired pressure ulcers (IAPUs) still ranges from 5⋅1% to 17⋅6% (3,4). The unique environment of the operating room makes preventing IAPUs during surgery more difficult than in other settings. Specifically, surgery patients lie immobile in the same position on the operating table for a prolonged period of time. As such, preventing pressure ulcers during surgery is typically not prioritised by surgeons.In recent years, the prophylactic effectiveness of soft silicone foam dressings in intensive care units has been reported .

Furthermore, several studies found that the application of a polyurethane foam dressing in the operating room reduced the risk of developing pressure ulcers during surgery.

We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual-center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient. IAPUs developed on the chest in 11 of 100 patients (11%). Polyurethane foam dressings were associated with a significantly higher rate of IAPUs than soft silicone foam dressings (11 versus 3, P=0.027). A multivariate logistic regression analysis revealed that a diastolic blood pressure of＜50mmHg(P=0.025, OR 3.74, 95% confidence interval [CI] 1.18–13.08) and the length of surgery (by 1 hour: P=0⋅038, OR 1⋅61, 95% CI 1⋅03–2⋅64) were independently associated with the development of IAPUs. The use of soft silicone foam dressings reduced the risk of IAPUs (P=0.019, OR 0.23, 95% CI 0.05–0.79) and was more effective than film dressings for preventing IAPUs in spinal surgery patients.

Case and method：

Figure 1：Dressing application. Soft silicone foam dressings was applied on left side of the chest and the iliac crest. Polyurethane film dressings was applied on right side of the chest and the iliac crest.

Figure2：Positioning methods on the Relton-Hall frame. The cut urethane foam mattresses were placed on the Relton-Hall frame pads, and the patient was placed in the prone position on the urethane foam mattresses. Both arms were fixed on external arm boards. The entirety of the lower limbs was placed on a pressure-distributing mattress over the operating table mattress, which was fixed in accordance with the physiological curvature. The face was held by a Protective Helmet System made of urethane foam cushion.

Results：

A total of 113 patients were assessed for eligibility during the study period. Six patients met the exclusion criteria, and seven patients did not provide their informed consent; thus, 100 patients were ultimately enrolled. We analysed the data of these patients.IAPUs developed in 11 of the 100 patients (11%) within 30 minutes after shifting the patient back into the supine position; 10 patients had Category I IAPUs, and one patient had a Category II IAPU with a blister. The IAPUs developed on the chest in all 11 cases (14 locations) and healed without deterioration before discharge. The number of IAPUs that developed on the side treated with polyurethane film dressings was significantly higher than that on the side treated with soft silicone foam dressings.

Conclusion:

Polyurethane film dressings can prevent shear force and friction , as can the multi-layered silicone foam structure of soft silicone foam dressings. To our knowledge, no other studies have so far compared the effectiveness of the prophylactic use of soft silicon foam dressings and polyurethane film dressing in the prevention of IAPUs in surgery with a Relton-Hall frame. This study showed that soft silicone foam dressings were more effective than polyurethane film dressings for preventing the development IAPUs in patients undergoing spinal surgery in the prone position using a Relton-Hall frame. On the side where soft silicone foam dressings were used, the odds ratio of IAPUs was less than one-quarter of that on the side where polyurethane

film dressings were used . Polyurethane film dressings are currently the best low-friction film dressing available . We concluded that soft silicone foam dressing reduced the development of IAPUs more effectively than polyurethane film dressings, even when surgery was performed in the prone position with the use of a Relton-Hall frame because the cushion was capable of reducing both shear force and friction.With regards to the clinical implications, our results suggest that applying soft silicone foam dressings during surgery may help prevent the development of IAPUs and reduce the interface pressure at the support surface without affecting positional fixation or the surgical procedure.

Yoshimura, Mine, et al. "Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the Border Operating room Spinal Surgery (BOSS) trial in Japan." International wound journal 15.2 (2018): 188-197.