The role of the perioperative prone position in the low recurrence of pressure injuries in the pelvic region

Author:

Fagotti de Almeida Carlos Eduardo1,Cirino dos Santos Ana Paula Bertole2,Biaziolo Cintia Fernandes Baccarin2,Mateus de Vasconcelos Elaine Cristine Lemes2,Oliveira Flavio Vasconi3,Jorge João Luís Gil1,Ferreira Marcus Castro1,Coltro Pedro Soler1,Junior Jayme Adriano Farina1

Affiliation:

1. Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil

2. Rehabilitation Center, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Brazil

3. Ribeirão Preto Medical School, University of São Paulo, Brazil

Abstract

Objective: A pressure injury (PI) is a localised area of damage to the skin and/or underlying soft tissue as a result of a sustained mechanical loading. There are three key aetiological mechanisms to PI formation—direct cell deformation, inflammatory oedema and ischaemic damage—which are typically activated sequentially to drive a spiral of injury. This article discusses the role of the perioperative prone position as a rational approach to reducing the recurrence of pelvic PI after reconstructive surgery. Method: Patients with deep PI in the pelvic region, who were operated on from 2011 to 2019, were retrospectively evaluated. The protocol of care included training in the prone position, followed by maintenance of the prone position for 4–6 weeks postoperatively. The reconstruction was performed with fasciocutaneous and myocutaneous local or regional flaps. Results: The study evaluated a total of 26 patients. The rate of recurrence of PIs was 15.4% (4/26) in the mean follow-up of 54 months. Regarding postoperative complications, four cases of partial dehiscence of the suture occurred. Conclusion: This perioperative protocol of maintaining a prone position seems to be safe for the patient, and it can be used to prevent or reduce the recurrence of deep PIs on the pelvic region after reconstructive surgery.

Publisher

Mark Allen Group

Subject

Nursing (miscellaneous),Fundamentals and skills

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