Face Tissue Pressures in Prone Positioning

Abstract

Pilot Study. The objective of this study was to compare face tissue pressures for 3 different prone head positioners in healthy, conscious individuals in the prone position. The incidence of intraoperatively acquired pressure ulcers has been reported to range from 12% to 66%; healthcare literature lacks information about lesions specific to the face. Risk factors include prolonged surgical times, immobility, inadequate positioning and/or padding, use of warming devices, and skin maceration. Spine procedures are often lengthy, and frequently require patients to be in the prone position. Thus, face pressure lesions have been observed after complex spine procedures. A variety of prone head positioners exist to reduce face tissue pressures encountered during prone procedures. The objective of this study was to compare face tissue pressures for 3 different prone head positioners in healthy, conscious individuals in the prone position. Fifteen subjects tested 3 prone face positioners, and face-pillow interface pressures for the forehead and chin were recorded over 15 minutes. The devices included a disposable polyurethane foam prone head positioner (VOSS Medical Product; San Antonio, TX); a face plate and mirror with a disposable foam prone head positioner (ProneView Protective Helmet System, Dupaco Inc; Oceanside, CA); a neoprene "dry flotation" device from ROHO (The ROHO Group; Belleville, IL). At all time points for the forehead and chin, the ProneView positioner and the ROHO neoprene pillow demonstrated significantly lower face-pillow interface pressures than the VOSS polyurethane pillow. An alternative to the current commercially available prone positioners exists as the ROHO neoprene pillow resulted in significantly lower forehead and chin pressures than the VOSS pillow and lower chin pressures than the ProneView pillow at all time points. A prospective, randomized clinical trial is needed to identify face-pillow interface pressures in anesthetized patients.