In 2019 when Dr. Gksoulias and I published “On the Origin of Intraoperative Pressure Injury: An Angiosomal Theory of Pressure Injury Formation,” I didn’t make a big deal about the photo above, but I think it’s time to talk about it.

To look at this heel pressure injury, I had to peel back the foam pad that had been placed there as a preventive measure. It’s time we asked ourselves whether a thin foam pad could prevent an ischemia reperfusion (IR) injury caused by the obstruction of a named blood vessel several centimeters proximal to the area.

Do we really think that the pad in the photo could prevent an ischemic injury that originates several centimeters away? They may work to prevent friction and sheer over the local area, but not IR injuries proximally. That’s why they fail.

My hospital spends half a million dollars a year on these pads for prevention. My hospital system spends $5 million a year on them as part of a “get to zero” campaign. I hate this slogan. It implies that using interventions like this, we COULD “get to zero” pressure injuries. We clearly aren’t stopping them all, and the reason may be that our interventions are not directed at the right pathophysiological process. I suspect that if we gave $5 million to a researcher in the field, they could come up with a mitigation strategy that did work.

For more information about this heel [ischemia reperfusion] injury, see my previous article Yes! It IS a Pressure Injury! An Ischemia Reperfusion Injury…