International Academy of Cosmetic Dermatology

PRESSURE RELIEF

Relieving pressure from a sore area of the skin that has developed due to prolonged bed rest can be a problem, whether from an accident or a chronic disease state. A simple answer that suggests itself is the use of a ring-shaped “doughnut” cushion. It would also seem that the “doughnut” cushion would be suitable for protecting open areas on such places as the heel, ankle, knee, elbow, or even the hip. How tempting it would be to cut holes in pieces of rubber foam and bandage these “do it yourself (DIY) doughnuts” in place.

Circumferential pressure
Unfortunately, ring-shaped cushions, either sat upon or bandaged in place, cause pressure all around the sore area. This (circumferential) pressure is often high enough to prevent efficient lymph drainage. If this is sustained for even a few hours, the sore skin can become edematous, slowing down the healing process.
In some instances, the circumferential pressure may be high enough and sustained enough to cause venous congestion within the ring. On “sat upon” doughnuts, such congestion causes discomfort or even a sensation of “pins and needles,” thereby, indicating that the cushion should be removed. DIY doughnuts, inflatable ones, and poorly designed commercial ones are the most troublesome. They are often more troublesome, if the skin is partially or completely pain-insensitive in the area concerned. Here, a decubitus ulcer or a diabetic ulcer may be developing, and circumferential pressure can lead to unsightly sub-dermal thrombosis, with the creation of deep ulceration.

Alternatives
When tempted to use a “doughnut” cushion, consider the possible consequences and use, instead, either a cushion that distributes pressure evenly over a large area or a specially designed cushion with a channel down the middle. Such cushions are available commercially, permitting the blood to circulate, whilst still relieving pressure from the sore area.

Peter T Lowthian, M.Phil, SRN
Watford, UK