Gel wheelchair cushions: a potential cold weather hazard

Paraplegia and quadriplegia with concomitant impairment of cutaneous sensation predisposes to secondary skin damage, most commonly due to pressure or heat. Cold exposure, however, can also damage the skin. This report describes a 19-year-old man with myelodysplasia and L3 incomplete paraplegia who sustained extensive freeze burns of the buttocks from sitting on a gel wheelchair cushion that had been left outside in freezing weather. When he initially presented for medical care, the lesions were described by his physician as ischial pressure sores. On careful further questioning, prompted because of the unusual margins of the lesions, the true etiology was determined. The medical and surgical management of this patient's cold thermal injury, the thermomechanical properties of gel wheelchair cushions, and the literature pertaining to cold injury in the population with impaired spinal cord function are discussed.