Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
Wound/Ostomy Program Team, VCU Health System, Richmond, Virginia, USA.
Int Wound J. 2020 Oct;17(5):1405-1423. doi: 10.1111/iwj.13408. Epub 2020 Jun 4.
An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning-related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.
在手术过程中，为了达到最佳的手术入路位置，患者可能需要在能够接受的手术体位和不造成组织损伤的体位之间进行权衡。本范围综述从生物力学和临床角度分析了与手术体位相关的组织损伤风险的现有最新证据，重点关注在不允许重新定位且限制使用动态或厚而软的支撑表面的约束性手术环境中预防组织损伤的挑战。为了有效预防术中获得性组织损伤，需要深入了解多学科病因，主要包括压疮（损伤）和神经损伤。缺乏这种理解通常会导致误解和增加患者的风险。因此，本文提供了关于潜在组织损伤类型、易受损伤的解剖部位、手术环境特有的风险因素（例如麻醉和器械的影响）、组织损伤风险与手术本身病理生理学之间复杂相互作用（例如手术切口的炎症反应）、手术患者风险评估及其局限性以及定位可用（包括新兴）技术的全面病因描述。本研究采用多学科和综合方法，综合了生物工程学和临床观点，这在以前的研究中是没有的。生物工程师和临床医生之间需要密切合作，例如在这里展示的那样，重新设计手术台、手术用支撑面、用于患者稳定的手术器械以及手术入路。每种类型的设备及其组合使用都应根据手术环境中对组织健康的两大威胁进行评估和改进：压疮和神经损伤。
