Pressure Necrosis
Constant pressure applied to parts of the body affects the underlying blood circulation. If perfusion
of a volume of tissue is compromised for a long enough period, ischemia results and
can lead to necrosis of the affected tissue. Such accessories as retractors, mattresses, railings,
and leg supports, if inappropriately designed, manufactured and utilized, can be that source of
excessive pressure that can be injurious to the patient during long operations (Gendron, 1988).
For example, the author investigated an incident in which a patient had suffered neurological
damage as a result of prolonged, high-pressure contact of a limb with the vertical elements of
the Pittman retractors, as shown in Figure 95-14. Surgical staff must be appropriately trained
to avoid such situations and to use adequate padding to distribute the force of a hard object
over a large area in order to minimize the pressure upon the patient’s vasculature.