Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID-19 pandemic

Lea Peko, Michelle Barakat-Johnson, Amit Gefen, Lea Peko, Michelle Barakat-Johnson, Amit Gefen

Abstract

Prone positioning is used for surgical access and recently in exponentially growing numbers of coronavirus disease 2019 patients who are ventilated prone. To reduce their facial pressure ulcer risk, prophylactic dressings can be used; however, the biomechanical efficacy of this intervention has not been studied yet. We, therefore, evaluated facial soft tissue exposures to sustained mechanical loads in a prone position, with versus without multi-layered silicone foam dressings applied as tissue protectors at the forehead and chin. We used an anatomically realistic validated finite element model of an adult male head to determine the contribution of the dressings to the alleviation of the sustained tissue loads. The application of the dressings considerably relieved the tissue exposures to loading. Specifically, with respect to the forehead, the application of a dressing resulted in 52% and 71% reductions in soft tissue exposures to effective stresses and strain energy densities, respectively. Likewise, a chin dressing lowered the soft tissue exposures to stresses and strain energy densities by 78% and 92%, respectively. While the surgical context is clear and there is a solid, relevant need for biomechanical information regarding prophylaxis for the prone positions, the projected consequences of the coronavirus pandemic make the present work more relevant than ever before.

Keywords: COVID-19; finite element modelling; pressure injury; prone position; silicone foam multi-layered prophylactic dressings.

© 2020 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
The model geometry and determination of boundary conditions: A, The three‐dimensional (3D) anatomically‐accurate computational finite element (FE) model of an adult head in a prone surgical or intensive care position. The frame on the left‐hand side documents measurements of facial interface pressures when the head of a prone subject is positioned on a donut‐shaped headrest. B, Mid‐sagittal cross‐section through the 3D FE head model with magnification to visualise the structure of the multi‐layered Mepilex Border Flex dressing (Mölnlycke Health Care, Gothenburg, Sweden) which is simulated to be applied prophylactically here, to protect the forehead (in the magnified cross‐section) and chin. C, Inferior views of the 3D FE head model when positioned on the donut‐shaped headrest with the applied forehead and chin dressings (right frame) and without dressings (left frame). The contours of the head support are also shown in both cases, for clarity
FIGURE 2
FIGURE 2
The effective stress distributions developed on the facial skin with applied Mepilex Border Flex (Mölnlycke Health Care, Gothenburg, Sweden) dressings (right frame) vs without dressings (left frame). The top and bottom frames show inferior and side views of the head in the prone position (with zooms of stress concentrations at the chin region), respectively
FIGURE 3
FIGURE 3
Strain energy density distributions on facial skin (top frames) and in subcutaneous fat (lower frames) from an inferior view of the head in the prone position, with applied Mepilex Border Flex (Mölnlycke Health Care, Gothenburg, Sweden) dressings (right column) vs without dressings (left column)
FIGURE 4
FIGURE 4
Cumulative percentages of soft tissue exposures to loading in volumes of interests (VOIs, marked as dashed boxes on the head model) containing facial skin and subcutaneous fat at the forehead (VOI1) and the chin (VOI2). The upper and lower plots per each VOI depict exposures to effective stresses and strain energy densities, respectively

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