The Importance of the Microenvironment of Support Surfaces in the Prevalence of Pressure Ulcers

Soft tissue breakdown is a major cause of disablement in the United States. External pressure has been the most frequently discussed stress factor in the formation of ulcers. Analysis of published data on the prevalence of pressure ulcers and interface pressures at various anatomic sites indicate a nearly non-existent or slightly negative correlation between prevalence and interface pressure for the general and the spinal cord injured populations respectively. This lack of direct relation suggests the major influence of environmental factors in addition to mechanical factors (pressure, shear strain and friction, etc.,) on ulcer formation and indicates the need for control of the support surface microenvironment. However, most of the reported results from studies evaluating support surfaces focus mainly on pressure relief and neglect to address adequately the environmental contributing factors of ulcer formation. Studies directly relating primary stress factors and tissue viability with prevalence and incidence of pressure ulcers are needed to better understand the benefits of pressure relieving support surfaces and to improve the effectiveness of prevention and treatment interventions. The effects of microenvironment on support surface function are reviewed here to aid the healthcare providers in the choosing of the most appropriate support surface to meet the patient's needs.