Use of Immersion therapy mattress with low air loss to facilitate healing of post myocutaneous flaps

                Historically the use of support surfaces in the treatment of myocutaneous flaps resulting from Stage IV pressure ulcers on the torso has been limited in our hospital to air fluidized therapy.  The WOC nurses were asked  to find an alternative  surface for post myocutaneous patients.   The professional staff recognized multifactorial concerns with the use of the fluidized therapy beds.  These concerns included staff injuries with patient transfers and patient safety.                                                

                In our search to  find a different support system, we  initially trialed a mattress that provided immersion therapy.  Immersion therapy simulates a fluid environment and immerses the patient into the surface.  During this evaluation  patients experienced  adverse outcomes  due to the microclimate of  the patient's skin.  Patients had problems with moisture and skin breakdown.

               In an attempt to manage the microclimate environment in these post myocutaneous patients, we trialed a new prototype Immersion therapy mattress with low air loss. Our 5 case studies consisted of post myocutaneous flap patients from stage IV torso ulcers.  The study was from 9/2013-2/2014.  All 5 patients were placed on the low air loss Immersion therapy mattress directly after surgery along with our hospitals total pressure ulcer management plan.  As part of our hospitals clinical pathway for post myocutaneous flap patients, all 5 patients were transferred to a critical access hospital.   The low air loss Immersion therapy mattress was transferred with the patient.  Upon discharge to home, all flap incisions were approximated and closed. Hospitalization days between both hospitals ranged from 4 - 7 ½ weeks.

                Our experience with this newer therapy was quite positive for patient outcomes; and feedback from our patients was favorable.  As a result of this study our hospital no longer uses air fluidized therapy for post myocutaneous flaps.  The response from our multidisciplinary team has been supportive of this change.