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Wounds Secondary to Sleep Position Part 2: Using Mattresses and Other Modalities to Prevent Pressure Injuries


For the patient, the prevention of sores and injuries is better than treating them. Pressure-relieving mattresses may be essential for preventing pressure injuries (bed sores). These mattresses aid in relieving and redistributing pressure and can thereby cause a reduction of friction and shearing. Pressure-relieving mattresses provide support for the body and reduce the amount of force applied to a given area. Thus, for bedbound patients and patients who are unable to reposition themselves, these types of beds can be especially beneficial.

Modalities Other Than Mattresses

How Offloading Boots Can Help Prevent Pressure Injuries and Lower Extremity Ulcers

Use of offloading boots is another method to prevent pressure injuries of the lower extremity. As we know, excessive pressure can build up while the patient is in bed. Offloading boots can be used to redistribute the pressure and cushion the lower extremity. These boots may be most effective at bony prominences. Most devices allow for plenty of ventilation and air circulation. Simply applying these offloading boots is not enough. The boots need to be continuously monitored to ensure that they have not shifted. Shifting of these boots can increase pressure to other areas.

In cases of malleolar wounds, foam egg crate–type boots can be modified by cutting a hole directly over the injury to offload the area. Kickstand-type devices can also be used to prevent internal and external rotation, thus further offloading a malleolar wound. In addition, offloading boots can provide huge psychological relief to the health care provider and the patient. Although shifting may occur with offloading boots, peace of mind is achieved knowing that there is some sort of offloading for the lower extremity.

How Posterior Splints Can Help Prevent Pressure Injuries and Heel Ulcers


Figure 1

In non–weight-bearing patients, we use posterior splints to offload heel ulcers and injuries (Figure 1). These devices are nonremovable by the patient but allow medical providers access to the wounds for dressing changes. This offloading device is available in nearly every hospital in the country and does not need to pass through a budget committee. Hsu et al1 described a technique using posterior splints to remove pressure from the heel to avoid a pressure injury (decubitus ulcer). The splint is designed to offload over the ulceration or injury while the splint is setting or drying by placing a roll of gauze over the ulceration or injury. Once hardened, the gauze roll can be removed, and the wound is offloaded. These splints work well with heel negative pressure wound therapy devices and may prevent heel ulcers or injuries.

How Specially Designed Cushions Can Help Prevent Pressure Injuries

Placing specially designed cushions at areas of increased pressure points can relieve pressure and allow for adequate blood flow. There are specially designed cushions on the market for the prevention of pressure sores and injuries. The devices may be fitted into wheelchairs, seats, or mattresses. Pillows can be used as well.

How Skin Care Products Can Help Prevent Pressure Injuries

Various skin care products may also be used to prevent pressure injuries (bed sores). Skin that is too dry, moist, or brittle should be evaluated with extra precaution. The following list contains various skin care products that can assist in the prevention of pressure injuries and can be used in tandem with offloading devices.

  • Skin-protecting dressings can shield the skin from friction.
  • Cleansing body lotions can clean and protect skin from incontinence.
  • Antimicrobial cleansers can help eliminate bacteria.
  • Skin protectants can provide a barrier for irritated or sensitive skin.

Different Types of Medical Mattresses

A vast range of medical mattresses are available for hospital, nursing home, and domestic settings. This section helps differentiate the different types of pressure-relief mattresses available.

Gel Mattresses

Gel mattresses provide a barrier between the patient and the contact surface. They conform to the patient’s body. These types of mattresses create a cooler sleeping surface, and the patients who use them tend to report a more comfortable sleep experience. The benefits of these beds include a cool sleeping surface and a reduction of pressure with weight redistribution. Although this type of mattress redistributes weight, it does not actively relieve pressure and is not suitable for patients at high risk for developing pressure injuries (bed sores).

Foam Mattresses

Foam mattresses can consist of different layers, zones, features, and densities. Foam mattresses are low-static mattresses that can allow the cells of the mattress to shift with the patient’s body. This property can decrease the risk of skin tears caused by patient movements. These types of mattresses can work well with patients who have a low risk of developing an ulcer or injury or who have superficial pressure injuries. The advantages of this type of mattress are that it conforms to the body, reduces the risk of shearing, relieves pressure by weight distribution, and contains air pockets that aid in additional reduction of pressure. Keep in mind that foam mattresses tend to hold body heat and may create a hotter surface. They also do not treat pressure injuries but aid in prevention.

Gel/Foam Hybrid Mattresses

Hybrid gel/foam mattresses are also available. They can be made with foam and air, as well as powered or nonpowered. These types of mattresses are suitable for patients that are at high risk of developing ulcers or injuries or with existing ulcers or injuries. Benefits include that they are more responsive than foam mattresses, are breathable, customizable, and can reduce motion transfer. The hybrid gel/foam mattresses, however, can be expensive and heavy and therefore difficult to move.

Low–Air Loss Mattresses

Low–air loss mattresses help heal pressure injuries that have already developed. They can deliver active therapy and can push air through drilled holes in the mattresses. These mattresses are designed for patients with skin breakdown. Benefits include that they are suitable for stage 1 to 4 pressure injuries, are automatic, and can help keep skin dry. Drawbacks include that they need to be connected to a power supply and they can be noisy, inhibiting sleep.

Alternating-Pressure Mattresses

Alternating-pressure mattresses are powered with air bladders. They are most effective for skin breakdown prevention. Benefits include that they are programmable, soothe muscle aches and pains, prevent skin breakdown, and are easy to use. Drawbacks include potential high costs and noise of use.

Low–Air Loss Mattresses With Alternating Pressure

Low–air loss mattress with alternating pressure can prevent and treat skin pressure. The mattress works through 2 therapy modes, including a programmable cycle time for deflation and static low air loss. Benefits include that 2 therapies are provided, an unmatched pressure redistribution surface and its static mode. Drawbacks include that these mattresses are for hospitals only and must be plugged into a power supply at all times.


Pressure injuries, specifically those secondary to sleep position, are not well described in the literature. Prevention of these injuries is preferable to treatment, if possible. Pressure-relieving mattresses and other offloading modalities can be essential for preventing pressure injuries.


  1. Hsu RY, Lareau CR, Born CT. Novel posterior splinting technique to avoid heel ulcers. Orthopedics. 2013;36(1):31-32.

About the Authors

Dr. Lenz is a Certified Wound Specialist Physician. He has a special interest in limb salvage and wound care including surgery to correct deformities causing lower extremity ulcerations. He uses the most technologically advanced wound healing treatments available. He has presented multiple research projects related to advanced wound care at national surgical conferences. He is a graduate of the New York College of Podiatric Medicine and completed a comprehensive medical and surgical residency at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois, where he served as Chief Resident. Dr. Lenz completed advanced surgical training in Germany and England, where he worked with international experts in diabetic foot surgery. He is dual board certified by the American Board of Wound Management and the American Board of Podiatric Medicine. He is a member of the American Podiatric Medical Association (APMA). Dr. Lenz is certified in hyperbaric medicine by the Undersea and Hyperbaric Medical Society. Dr. Lenz is certified in foot surgery by the American Board of Foot and Ankle Surgery.

Dr. Hussain is a foot and ankle surgery resident at RWJBH-Community Medical Center in Toms River, New Jersey. Fahad received his bachelor’s degree in biology from The University of Houston, and his medical degree from Temple University School of Podiatric Medicine. Dr. Hussain is surgically inclined and has a devoted interest in reconstructive surgery, limb salvage, cosmetic surgery, trauma, and minimally invasive surgery. 

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.