Advanced Wound Technologies

Microsolo900T Low Pressure/Shear Support surface for the Surgical Table supplying Three Dimensional Volumetric Support at the speed of light.

If you thought it was difficult to predict the development of a pressure sore under what might be considered as conventional clinical circumstances, it only gets worse on a surgical table during extended surgical procedures. Even the most commonly used assessment scales such as the

Norton scale, Braden Scale and Waterloo Scale, or other well conceived assessment tools do not take into consideration the extraordinary intrinsic and extrinsic physiological and bio-mechanical issues present in the surgical suite. Except for the presence of these extraordinary issues one may never develop a pressure sore in a normal clinical setting.

The introduction of anesthetic agents and pharmaceuticals ( which induce hypotension ) and cooling blankets (designed to retard tissue metabolic activity) play havoc with peripheral circulation and normal tissue metabolism. Adding to this dilemma, immobility on a very hard surface for an extended period of time creates an environment conducive to the development of subcutaneous tissue infarction (pressure sores). Interestingly, studies as rare as they are on this particular subject demonstrate that even though a 7 to 29% range of incidents for pressure sores exists in the general acute care population, the incidence increases to an alarming 12 to 66% rate for pressure sores acquired intra-operatively.

Studies have shown that as the length/time of surgery increases, the incidence/percentage of patients with pressure sores also increases. Findings suggest that 8.5% of all surgical patients who underwent operative procedures in excess of 3 hours developed pressure ulcers. Immediate postoperative clinical findings of non-blanchable erythema of the skin within days progressed to more advanced stages of pressure sores. Interestingly, more than 17% of the patients who underwent vascular surgery developed pressure sores during the procedure. This would be expected as many of these patients already have advanced vascular disease. Also, aging in

general carries with it many more risk factors, the least of which is the skin's inability to withstand extended periods of mechanical trauma.

Why no real solution until now ? Practicality, need for surface stability and conventional technology does not allow placement of a dynamic pressure (redistribution) relief surface (low air loss) on a surgical table, even though the same laws of physics (pressure offloading) which apply to the surgical table also apply to hospital beds and wheelchair support surfaces. Consequently the only solution has been static gel or viscoelastic foam surfaces. These surfaces by their very physical nature will not supply three dimensional volumetric redistribution of pressure (Figure 2 ).

( Click to Enlarge)

CT scan of subject in prone position (control scan). Notice natural symmetry of the gluteal area. Distances from the most posterior point of the ischeal tuberosities to the skin surface are approx. 100mm. less the effects of gravity.

Limited compressibility of these surfaces creates distortion and compression of soft tissue (tensile stress) causing bony prominences to impale into muscle and subcutaneous layers thereby compromising microcirculation exacerbating an already deteriorating situation.

What is Three Dimensional Volumetric Pressure Redistribution? It is the ability of the support surface to conform to the anatomical characteristics of the subject in suspension (cradling); therefore, redistributing pressure without distorting/compressing soft tissue.
( Figure 3)

( Figure 2 Click to Enlarge)

CT scan of subject supine position on a very commonly used viscoelastic temperature sensitive low pressure surgical table surface. Subcutaneous tissue and muscle has compressed and formed to the shape of the CT table (bottoming out). The gluteal fold has all but disappeared. Distance of ischeal tuberosities(IT) to the skin surface has diminished by approx 25mm. The left and right IT are impaling the muscle tissue.

The normal orientation of subcutaneous tissue, muscle and bone is maintained. Additionally, bony prominences do not impale muscle and subcutaneous tissue.

( Figure 3 Click to Enlarge)

CT scan of subject supine position on the Microsolo surface. Natural gluteal symmetry maintained, normal orientation of bone, muscle and subcutaneous tissue maintained. Distances from IT to surface of skin actually increased from the prone position. No mechanical trauma present.

. Microprocessor controlled auto profiling of patients height, weight and girth (no manual set up required). System will re-adjust if patient position is changed. Adjustment cycle immediate.

. No air loss through support surface maintaining the aseptic environment of the operative field.

. Surfaces designed to accommodate Amsco/Steris, Skytron, Castle and other surgical tables and replaces existing standard table pads.

. Rock solid stability as the patient is cradled in a three dimensional manner.

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