Support Surfaces

Welcome to the first article in a new series on support surfaces.  The use of support surfaces is a critical component of any wound care plan, essential to prevent and treat skin breakdown.

What is a Support Surface?

A support surface is a specialized device that redistributes pressure to achieve optimal management of tissue loads, micro-climate, and other therapeutic functions.¹ Support surfaces redistribute the body’s weight and protect the skin, while providing for proper body alignment, comfort and postural control.^1–3

Support Surface Categorization

Support surfaces may be categorized in five ways:²

1. By extent of pressure redistribution – Preventative intervention support surfaces, in which pressure is reduced but not consistently below 32 mmHg, are used for patients at risk of skin breakdown or as part of a treatment plan for partial-thickness ulcers. Therapeutic support surfaces, in which pressure is consistently reduced to below 32 mmHg, are used in patients with advanced wounds, such as stage III and IV pressure ulcers.²
2. By form of device – Many types of support surface are available for use in either the seated or supine position. Typical support surfaces include mattresses, integrated bed systems, mattress replacements, mattress overlays, and seat cushions.²
3. By power source – Support surfaces may be powered, nonpowered, or static. Static surfaces are the most basic type of device, and offer the advantages of low cost and an absence of moving parts. However, powered and nonpowered devices offer additional features such as low air-loss, alternating pressure, and lateral rotation.
4. By redistribution medium – The most common materials used in support surfaces include foam, water, gel, and air. All these materials have their own advantages and disadvantages, and the optimum materials should be selected on a case-by-case basis.
5. By Medicare reimbursement group – Medicare categorizes support surfaces into three groups for the purposes of reimbursement. The three Medicare groups are devices for preventive intervention, including foam dry overlays or mattresses; devices for therapeutic intervention, including powered overlays and mattresses and low air-loss mattresses; and air-fluidized beds.

These themes will be explored in greater depth over the coming weeks.

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References

1. Brienza Dam, Geyer MJ, Sprigle S, Zulkowski K. Pressure redistribution: seating, positioning, and support surfaces. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2^nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.
2. Nix DP. Support surfaces. In: Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3^rd ed. St Louis, Missouri; Mosby Elsevier; 2007.
3. Bates-Jensen B. Pressure ulcers: pathophysiology and prevention. In: Sussman C and Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007