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Face Tissue Pressure in Prone Positioning: A Comparison of Three Face Pillows While in the Prone Position for Spinal Surgery

Grisell, Margaret, MD, MBA; Place, Howard M., MD

doi: 10.1097/BRS.0b013e31818b9029

Study Design. This is a prospective, randomized study.

Objective. The purpose was to compare the tissue-pillow interface pressures at the forehead and chin in patients positioned in the prone fashion for spinal surgery on each of 3 facial positioners.

Summary of Background Data. Facial pressure ulcers have been infrequently observed after spinal surgery requiring prone positioning. This requires the use of a specially designed head positioner to maintain spinal alignment and to allow space for the endotracheal tube.

Methods. We enrolled 66 consecutive elective thoracic and/or lumbar surgery patients from 18 to 65 years of age. Patients were randomized on entry into the study to 1 of 3 positioners. Facial tissue pressures were measured at the patient’s forehead and chin at times 0, 5, 15, and 60 minutes of positioning. The integrity of the patient’s skin was recorded and classified at the end of surgery.

Results. The pressures measured for the Dupaco positioner were lower at all time points at both the forehead and the chin in comparison with the other 2 positioners (P < 0.05). The ROHO and the OSI positioners created similar chin pressures at all time points (P > 0.05). The pressures at the forehead for the ROHO positioner were significantly less than those for the OSI positioner at all time points (P < 0.05). Ten patients on the OSI positioner had pressure ulcers at the end of the procedure.

Conclusion. The Dupaco ProneView Protective Helmet System is superior to both the OSI and the ROHO positioners in decreasing forehead and chin tissue interface pressures during prone position surgery.

Facial pressure ulcers have been observed in patients positioned in the prone position for spinal surgery. This study evaluates facial tissue pressures obtained on each of 3 head positioning devices used for this purpose.

From the Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, MO.

Acknowledgment date: June 25, 2008. Revision date: July 22, 2008. Acceptance date: July 25, 2008.

The device(s)/drug(s) is/are FDA approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Howard M. Place, MD, Department of Orthopaedic Surgery, Saint Louis University, 7th Floor Desloge Tower, 3635 Vista @ Grand Avenue, Saint Louis, MO 63110; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.