Study design: This is a prospective, randomized study.

Objective: The purpose was to compare the tissue-pillow interface pressures at the forehead and chin in patients positioned in the prone fashion for spinal surgery on each of 3 facial positioners.

Summary of background data: Facial pressure ulcers have been infrequently observed after spinal surgery requiring prone positioning. This requires the use of a specially designed head positioner to maintain spinal alignment and to allow space for the endotracheal tube.

Methods: We enrolled 66 consecutive elective thoracic and/or lumbar surgery patients from 18 to 65 years of age. Patients were randomized on entry into the study to 1 of 3 positioners. Facial tissue pressures were measured at the patient's forehead and chin at times 0, 5, 15, and 60 minutes of positioning. The integrity of the patient's skin was recorded and classified at the end of surgery.

Results: The pressures measured for the Dupaco positioner were lower at all time points at both the forehead and the chin in comparison with the other 2 positioners (P < 0.05). The ROHO and the OSI positioners created similar chin pressures at all time points (P > 0.05). The pressures at the forehead for the ROHO positioner were significantly less than those for the OSI positioner at all time points (P < 0.05). Ten patients on the OSI positioner had pressure ulcers at the end of the procedure.

Conclusion: The Dupaco ProneView Protective Helmet System is superior to both the OSI and the ROHO positioners in decreasing forehead and chin tissue interface pressures during prone position surgery.