The recliner position: Modified operating position for burn surgery

Abstract

Introduction: Excision and grafting of burns to the shoulders pose special problems stemming from the difficulty in obtaining surgical access to the entire burn wound with the patient in one position. We describe a positioning technique, which allows access to circumferential burns of the shoulders and posterior portions of the neck. Observation: Access to burns to the shoulders for excision and grafting usually requires the need to turn the patient from the supine to the prone position intraoperatively, with the potential complications associated with re-positioning. These include, but are not limited to, prolonged anesthesia time, risks of shearing the skin grafts and bleeding under the grafts. We describe the recliner position, which provides surgical access to these types of wounds and permits the excision and grafting in one operation. In addition to improved exposure of the surgical site, potential advantages of this position include a reduction of bleeding due to lowered venous pressures and improved pulmonary function due to the redistribution of blood flow to the lower and better ventilated lung segments. Conclusion: The recliner position, when used to excise and graft burns to the shoulders and posterior portions of the neck, removes the necessity to reposition the patient, thereby reducing intra-operative time and complications associated with conventional position.