Offloading & Positioning

The Power of Offloading and Positioning

While contamination and infection can be one of the biggest roadblocks to wound healing, wound offloading and body repositioning can be one of your best allies in trying to heal your wound.

By 'repositioning,' we mean redistributing your body weight on a regular basis to continuously redistribute pressure around your wound site. By 'offloading,' we mean using one or more pillows or using a body positioner like a cushioned wedge, donut, or padded booties to help take pressure off your wound.

When you have continuous pressure on an area of skin or on a wound, you can end up disrupting blood flow to that tissue, causing worsening tissue damage. Excessive pressure can have the same effect on diabetic, venous, and other wound types as well.

Repositioning in Bed

If you're someone confined to the bed for long periods of time, it's a good idea to change your body position every couple of hours. This schedule helps redistribute pressure more evenly across your body parts and reduces the risk of developing or worsening an ulcer.

Patient repositioning is critical for minimizing tissue damage due to limited mobility. Even small shifts in position can make a significant difference.

• Reposition at least every 2 hours

• Use the 30-degree side-lying position to avoid direct sacral pressure

• Elevate heels completely off the mattress surface

• Use pillows or foam wedges between bony prominences

• Document repositioning times to ensure consistency

Sitting in a Chair

When it comes to sitting in a chair, it's best to limit the amount of time you spend in that position. Prolonged sitting can put pressure on certain areas and increase the injury risk for new and existing pressure ulcers.

As a general guideline, try to avoid sitting in the same position in the same chair for longer than one hour at a time. If possible, it's a good idea to take breaks and move around a bit before returning to a seated position.

Offloading Tools and Devices

Several specialized tools can help with repositioning and protecting vulnerable areas. These devices are designed to redistribute pressure and provide support where it's needed most.

• Heel protector boots – Suspend heels completely off surfaces

• Body wedges – Support 30-degree side-lying positioning

• Pressure-redistribution mattresses and overlays

• Specialized wheelchair cushions

• Donut-style cushions for seated pressure relief

• Total contact casts for diabetic foot ulcers

Dr. May's Recommendations

Among these tools, I highly recommend leg elevators and body wedges for individuals with severely limited mobility. Positioners provide excellent support to help treat and protect the more vulnerable areas like the feet, heels, sacrum, and back. They can significantly aid in the healing and prevention of wounds, so I cannot recommend them enough for my patients.

I generally suggest that anyone with a chronic wound and any mobility limitations use some type of designated pillow, positioner, or offloading device. Even if you don't have a wound right now, using such devices as a preventive measure can help reduce the risk of developing pressure wounds in the future.

Remember, offloading and body repositioning are simple yet very, very powerful techniques to support wound healing. By addressing the issues of pressure on an affected area, we can improve blood circulation, minimize tissue damage, and help your wound heal most efficiently.