A novel technique to minimize facial pressure ulcers during prone surgery: A randomized controlled trial

The prone position is widely used in spinal surgery. However, facial pressure ulcers (FPU) associated with the prone position are a significant cause of postoperative morbidities. Numerous methods have been described for preventing these lesions; however, practical and universally applicable solutions remain elusive. A novel approach has been described that incorporates cast padding placed over prone pads with extensive facial draping in an attempt to reduce the incidence of FPU. The purpose of this study is to evaluate the effectiveness of this preventive measure in reducing the incidence of FPU in patients undergoing prolonged spinal procedures in the prone position.

This was a prospective, randomized trial. Patients undergoing spine surgery and staying in a prone position for more than 6 hours were included. All patients were evaluated in the early postoperative period, and clinical follow-up was done for at least 6 months after surgery to monitor for potential complications and delayed wound healing. Patients were randomized into 2 groups: group A received standard anesthesia preparation with routine head positioning, while group B used prone pads wrapped with cast padding and had the patients' faces covered by a surgical drape. In addition, the results were analyzed based on surgical indications and categorized into degenerative and deformity subgroups. The FPU was classified according to the National Pressure Ulcer Advisory Panel Staging System.

The study included 29 and 28 patients in groups A and B, respectively. The FPU rate was significantly higher in group A (82.8%) than in group B (57.1%) across both degenerative (group A, 75.0%; group B, 55.0%) and deformity subgroups (group A: 100%, group B: 62.5%; P = .045). Notably, the FPU rates in the deformity subgroup (82.4%) exceeded those in the degenerative subgroup (65.0%); however, the difference was not statistically significant (P = .224).

Wrapping prone pads with cast padding and fully covering the face with a surgical drape is a simple, time-efficient, and universally applicable method that significantly reduces the incidence of FPU associated with the prone position.