The biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting prone surgical patients from chest injuries on the operating table

Abstract

Pressure ulcers are soft-tissue damage associated with tissue exposure to sustained deformations and stress concentrations. In patients who are proned for ventilation or surgery, such damage may occur in the superficial chest tissues that are compressed between the rib cage and the support surface. Prophylactic dressings have been previously proven as generally effective for pressure ulcer prevention. In this study, our goal was to develop a novel computational modelling framework to investigate the biomechanical efficacy of a dressing with a soft cellulose fluff core in protecting proned surgical patients from chest pressure ulcers occurring on the operating table, due to body fixation by the Relton-Hall frame. We compared the levels of mechanical compressive stresses developing in the soft chest tissues, above the sternum and ribs, due to the trunk weight, whilst the body is supported by the Relton-Hall frame pads, with versus without the prophylactically applied bilateral dressings. The protective efficacy index for the extremely high stresses, above the 95th-percentile, were 40.5%, 25.6% and 24.2% for skin, adipose and muscle, respectively, indicating that the dressings dispersed elevated soft-tissue stresses. The current results provide additional support for using soft cellulose fluff core dressings for pressure ulcer prophylaxis, including during surgery. K E Y W O R D S computer model, deep tissue injury, pressure ulcer/injury prophylaxis, protective efficacy, surgical positioning Key Messages • chest pressure ulcers are common in prone patients undergoing spinal surgery • the chest tissues are compressed between the rib cage and the fixation frame

The incidence of intraoperatively acquired pressure injuries in the park‐bench position was reduced by applying soft silicone multilayer foam dressings

“…In our previous study on the Relton‐Hall frame, which is used to fix the body in the prone position during posterior spinal surgery, we reported that SMD was more effective than film dressing in preventing IAPIs 20 . A dressing with a soft cellulose fluff core distributes stress concentrations to the chest in surgical patients prone on the surgical table 21 . One of the primary PIs prevention should be for minimising deformations by either reducing the peak strain/stress values in tissues 11 .…”

“… 20 A dressing with a soft cellulose fluff core distributes stress concentrations to the chest in surgical patients prone on the surgical table. 21 One of the primary PIs prevention should be for minimising deformations by either reducing the peak strain/stress values in tissues. 11 SMD is recommended as a prophylactic dressing in AORM guidelines.…”

A Polyelectrolyte Colloidal Brush Based on Cellulose: Perspectives for Future Applications

“…The advantages of a wider application of cellulose-based materials as a new type of absorbents or fillers are related to their abundance, low cost, easy recycling, and biocompatibility. These properties are of special interest for application in different practical fields such as environmental protection [1,2], energy storage [3], garment design [4], surgical pads [5], wound healing [6][7][8], absorbent hygiene products [9], pharmaceuticals [10][11][12], and 3D printing [13]. Cellulose-based gels are also studied as future materials for food packaging and plant agriculture [14], antimicrobial [15], and electroactive [16] materials.…”