1248 - The Low Air Loss Advantage in Inpatient Spinal Cord Rehabilitation

Case Diagnosis: A 44-year-old male with C3 AIS A traumatic spinal cord injury was admitted to inpatient rehabilitation with gluteal and sacral moisture associated skin damage that significantly improved once he transitioned to a low air loss microclimate management bed.

Case Description: The patient admitted as a level one trauma following motor vehicle crash. MRI cervical spine showed spinal cord edema with hematoma at C3-4 status post anterior decompression. After 26 days, he transferred to inpatient rehabilitation with diagnosis of C3 AIS A tetraplegia. He was placed on an alternating pressure air mattress with a low air loss microclimate management overlay. On admission, he had evidence of 1x2 cm superficial skin breakdown in the left buttock and intergluteal cleft. He was continued on every 2 hour turns and topical barrier cream was applied. Six days later, the wound extended to bilateral buttocks measuring 9x11x0.4 cm. He was transitioned to a low air loss microclimate management bed and continued the same protocol. His skin healed over the next 21 days and measured 5x2x0.2 cm at time of discharge. He had complete resolution of skin breakdown at wound care clinic follow up.

Discussions: Persons with traumatic spinal cord injury are at increased risk of developing moisture associated skin damage especially in the setting of incontinence. Despite pressure prevention protocols and barrier creams, our patient’s skin breakdown progressively worsened until he was switched to a low air loss mattress that provided air flow to maintain the skin microclimate and relieved pressure to promote perfusion and healing.

Conclusions: Physiatrists should closely monitor patients with spinal cord injuries for sacral skin breakdown and consider alternative mattress options as part of management in the acute setting. Prompt identification and treatment can prevent further complications such as full epidermal breakdown that leads to frequent hospital readmissions and creates a significant healthcare cost burden.