Abstract
To explore the clinical effect of “micromovement” in preventing intraoperative acquired pressure injures (IAPIs) among patients experiencing surgery in supine position. A total of 200 patients accepting elective surgery in supine position from 10 May 2023 to 4 July 2023 at Shulan (Hangzhou) Hospital were selected and randomized into two groups (experimental group, n = 100; control group, n = 100). For control group patients, soft silicone foam dressing was applied to the sacrococcygeal region. On the basis of the treatment for control group patients, “micromovement” was implemented among experimental group patients. During this process, the operating table was tilted for 15° leftwards and rightwards alternately every 1 h, and the tilt angle was maintained for 5 min to prevent IAPIs. Finally, comparisons between the two groups were made in terms of the sacrococcygeal IAPI incidence, relative temperature differences (ΔT) on sacrococcygeal skin, and job satisfaction of nurses. Compared with control group patients, patients from the experimental group exhibited lower IAPI incidence (2% vs. 10%), reduced ΔT between the sacrococcygeal skin and surrounding normal skin [0 (−0.1, 0.1) vs. 0.2 (−0.2, 0.4)], and elevated job satisfaction of nurses (80% vs. 66%). All the differences were statistically significant (p < 0.05). “Micromovement” implemented intraoperatively among patients receiving surgery in supine position is able to lower the IAPI incidence by five times and elevate job satisfaction of nurses.
Keywords: intraoperative acquired pressure injury, job satisfaction of nurses, “micromovement”, patients undergoing surgery, supine position
1. INTRODUCTION
Pressure injury (PI) is a localized injury in the skin or subcutaneous soft tissue caused by continuous pressure, shear, or friction, or both. 1 Intraoperative acquired pressure injury (IAPI) refers to the PI that occurs during the surgical process in patients, often occurring 1–3 days after surgery, 2 with an incidence rate of up to 4.7%–66.0%. 3 IAPIs intensify both the physiological and psychological burden on patients. As PI progresses, the incidence of postoperative complications goes up and the length of hospital stay is extended, thus adding difficulty to nursing and elevating the consumption of medical resources. 3 Moreover, there is also an increase in the readmission and mortality rates of IAPI patients within 30 days after surgery. 4 IAPI is one of the sensitive indicators measuring the specialized care quality in operating rooms. In the review criteria of tertiary general hospitals, IAPI is regarded as the key indicator evaluating clinical care quality, and research on current PI prevalence is taken as a link in continuous quality improvement. 5 In this context, IAPI prevention and the reduction of its incidence are highly valued, and numerous scholars have concentrated on the development and improvement of IAPI prevention measures. 6 , 7
Previous study anaesthesia duration (odds ratio [OR] 1.005) and total time of diastolic blood pressure <50 mmHg (OR: 1.007) were significantly associated with IAPI. 8 Skin surface temperature is another intrinsic factor related to PI. 9 However, the direct force of continuous pressure on the skin is the primary inducer of PI, 7 while repositioning can help reduce local skin pressure and shorten pressure duration. It has been previously highlighted that the optimal strategy of PI prevention is to reposition at least once every 2 h with a frequency of at least 15 min, and that skin pressure is minimal in the 30° lateral position. 10 Considering the specialty of surgical procedures, the present study proposed the concept of “micromovement”: the tilt of the operating table was changed by 15° every hour, with each tilt angle kept for 5 min. Based on our clinical practices and previous findings, we hypothesized that the intraoperative prophylactic use of foam dressing combined with “micromovement” could lower the incidence of IAPI among patients operated in supine position.
2. SUBJECTS AND METHODS
2.1. Subjects
This prospective randomized controlled trial was approved by Ethics Committee of the Shulan (Hangzhou) Hospital (20220074B), and written informed consent was obtained from all subjects participating in this trial. The trial was registered prior to patients enrollment at https://www.chictr.org.cn/showproj.html?proj=44739 (ChiCTR ChiCTR2300071121, Principal investigator: Yaxian Jin, Date of registration: May 5, 2023). The study was conducted at Shulan (Hangzhou) Hospital between 10 May 2023–4 July 2023.
Inclusion criteria: (1) patients aged 18–70 years at American Society of Anesthesiologists (ASA) Grade I–II; (2) patients receiving elective abdominal surgery under general anaesthesia in supine position (surgery duration ≥2.5 h); (3) patients who were transferred to surgical wards postoperatively.
Exclusion criteria: (1) patients who had already experienced PIs before surgery; (2) patients suffering from dermatologic conditions that impact PI observation, such as eczema, psoriasis, vitiligo, or co‐infection of skin at the pressure‐bearing sites; (3) patients accepting robot‐assisted laparoscopic surgery; (4) patients refusing to participate in our trial.
Removal criteria: (1) patients who withdrew from the trial; (2) patients requiring high doses of vasoactive drugs due to intraoperative blood loss of more than 500 mL, shock or cardiac arrest.
All the patients had understood trial procedures and signed the informed consent form before participating in the trial.
2.2. Methods
2.2.1. Trial design
The present investigation is an interventional prospective study adopting randomized grouping method and blinded design. Randomization method: Excel was utilized to generate random integers from 1 to 200 without repetitions. Patients assigned numbers of 1–100 were included in the control group, while those given with numbers of 101–200 were enrolled in the experimental group. Blindness method: trial recorders, assessors, subjects, and data statisticians were blinded to treatment protocols. The skin condition of patients before and after surgery was evaluated by two nurses: one circulating nurse who was unaware of the experimental protocol and one nurse from the Post Anaesthesia Case Unit (PACU). When there was disagreement between two of them, another nurse was invited to participate, and the final evaluation result was obtained on a 2‐to‐1 basis. The PACU nurse measured the patient's skin temperature.
2.2.2. “Micromovement” method
After patients were taken into the operating room, their back skin conditions were checked, venous accesses were routinely established, and anaesthetic monitoring was performed. Subsequently, anaesthesia induction and trachea intubation were carried out. Timing started at 0 h immediately after anaesthesia induction. At the same time, the Level key on the operating table (Dräger Electro‐hydraulic Operating Table, OPT 30/1, OPT SurgiSystem S.r.l, Italy) was pressed and the “micromovement” record sheet was created. The operating table was tilted to the right for 15° during the first 1 h of surgery and the tilt angle was maintained for 5 min; while during the second 2 h, the operating table was tilted to the left for 15° and the tilt angle was also kept for 5 min. The rightward and leftward tilting schemes were implemented in turn until the end of the surgery.
2.2.3. Grouping information
For control group patients, soft silicone foam dressing was adopted to prevent PIs. The silicone foam dressing of 12.5 × 12.5 cm (Biatain, Hotedam 1, 3050 Humlebaek, Denmark) was applied to the sacrococcygeal region and two shoulder blades of each patient after skin condition evaluation by circulating nurses. On the basis of the treatment given to control group patients, the “micromovement” protocol was also implemented on experimental group patients. The intraoperative body temperature of patients in both groups was kept at 36°C or above. During the surgery, patients with mean arterial pressure (MAP) <65 mmHg were injected with ephedrine or phenylephrine intravenously, and patients with heart rate (HR) <50 bpm were intravenously administered with atropine of 0.5 mg. The MAP was measured invasively on a multi‐function monitor (Datex‐Ohmeda, Hoevelaken, the Netherlands) and stored by DoCare Anaesthesia Clinical Information System (Medical System, Shuzhou, China). MAP was recorded every 5 min in the anaesthesia record sheet, and the proportion of patients with MAP<65 mmHg was calculated.
2.3. Observation indicators
2.3.1. IAPI incidence
After the surgery, the sacrococcygeal skin conditions were assessed by two nurses of the operating room and post‐anaesthesia care unit (PACU) who were unaware of our study protocols. The PI staging criteria formulated by the National Pressure Ulcer Advisory Panel (NPUAP) in the United States (Table 1) were followed. 11
TABLE 1.
Staging and manifestations of skin PIs formulated by NPUAP in 2019.
| Stage | Manifestations |
|---|---|
| Stage I | Intact skin with local erythema that could not subside after pressing (i.e. skin redness) |
| Stage II | Partial skin defects with exposed dermal layers |
| Stage III | Full‐thickness skin defects |
| Stage IV | Full‐thickness skin and tissue losses with visible fascia (soft connective tissue that holds the body structure in place), muscle, tendon, ligament, cartilage, or bone |
| Unstageable PIs | Full‐thickness skin and tissue defects obscured by decayed flesh or eschar (dead tissues), making it impossible to determine PI severity |
| Deep tissue PIs | Local injuries of persistent, non‐blanchable deep red, maroon, purple discoloration or epidermal separation, revealing a dark wound bed or blood‐filled blister |
2.3.2. Relative temperature differences on sacrococcygeal skin
Using the non‐contact infrared thermometer (Berrcom, JXB‐178, Guangzhou Berrcom Medical Device Co., Ltd., Guangzhou, China), skin temperature of patients was measured based on corresponding instructions. To minimize the influence brought by confounding factors such as room temperature, surgical approaches, and different temperature of different body parts, the relative temperature difference (ΔT) on the sacrococcygeal skin was utilized to reflect the temperature changes at the sacrococcygeal skin. ΔT on the sacrococcygeal skin referred to the temperature difference between the test area (mean temperature within the 5‐cm‐diameter circular area at the center of the sacrococcygeal region, T1) and the surrounding area (mean temperature within the 5‐cm‐diameter circular area that was in the body mid‐axis and over 10 cm away from the coccyx, T2) (ΔT = T1–T2). 12 Temperature measurement was performed in the PACU, during which the room temperature was set at 24°C and the thermometer was held 3–5 cm away from the areas to be measured. Each part was measured twice and the average value was calculated.
2.3.3. Job satisfaction of nurses
The questionnaire designed by our hospital was applied to investigate job satisfaction of nurses, which consisted of five items: operability, repeatability, clinical practicability, work intensity, and economy. Each item was assigned a score of 0, 1, or 2 points, with a higher score indicating the greater affirmation to the item. The results were presented on a 10‐point scale: 0–4 points, unsatisfactory; 5–8 points, satisfactory; 9–10 points, extremely satisfactory. Calculation formula: Satisfaction (%) = (number of nurses feeling satisfactory + number of nurses feeling extremely satisfactory)/total number of nurses × 100%.
2.4. Case number estimation and statistical analysis approaches
IBM SPSS 21 and GraphPad Prism7.0 were adopted for statistical analysis. Measurement data conforming to normal distribution were presented as mean ± standard deviation (SD), and their intra‐group comparisons were made through the t test. While measurement data of skewed distribution were expressed as M (P25, P75), and the data of the two groups were compared via the Mann–Whitney U test. Enumeration data were exhibited as case numbers (rates) and were compared by the χ2 test. The test level (α) was set at 0.05.
G*Power 3.0.10 software was used for sample size estimation. The detailed indicators were set as follows: IAPI incidence was taken as the estimation index of the sample size, test level (α) was = 0.05, (1‐β) was = 0.85, effect size was = 0.22, and case numbers of both groups were equal. The total sample size was calculated to be 186. However, given the number of removed cases, the sample size was enlarged by 10% and a total of 200 patients were finally enrolled.
3. RESULTS
3.1. Comparison of patient baseline data between two groups
Inter‐group comparisons were made regarding the parameters of age, sex, body mass index (BMI), ASA stages, preoperative comorbidity (diabetes, hypertension), preoperative plasma albumin concentration, surgical approach, surgical type, surgical duration, intraoperative blood loss, and incidence of intraoperative hypotension (demonstrated by the proportion of patients with MAP <65 mmHg in the present research). No statistically significant difference was noted (p > 0.05) (Table 2).
TABLE 2.
Comparison of patient baseline data between two groups.
| Variables | Experimental group (n = 100) | Control group (n = 100) | t/Z/χ2 value | p‐Value |
|---|---|---|---|---|
| Sex (male/female) | 56/44 | 52/48 | 0.322 | 0.570 |
| BMI (kg/m2) | 23 ± 3 | 24 ± 3 | 1.279 | 0.202 |
| Age (years) | 61 ± 7 | 62 ± 6 | 1.617 | 0.108 |
| Preoperative plasma albumin concentration (g/L) | 3.9 ± 0.5 | 3.9 ± 0.4 | 1.866 | 0.064 |
| Diabetes (n (%)) | 16 (16) | 17 (17) | 0.191 | 0.849 |
| Hypertension (n (%)) | 17 (17) | 15 (15) | 0.061 | 0.951 |
| Surgical approaches (endoscopic/open) | 90/10 | 88/12 | 1.247 | 0.264 |
| Surgical types (n (%)) | 1.938 | 0.378 | ||
| Pancreaticoduodenectomy | 44 (44) | 45 (45) | ||
| Radical surgery for liver cancer | 33 (33) | 30 (30) | ||
| Radical surgery for gallbladder cancer | 23 (23) | 25 (25) | ||
| Bleeding volume (mL) | 216 ± 46 | 210 ± 43 | 1.324 | 0.187 |
| Surgical duration (min) | 310 ± 31 | 315 ± 28 | 1.357 | 0.176 |
| Proportion of patients with MAP ≤65 mmHg (%) a | 6.7 | 6.1 | 0.548 | 0.534 |
Note: Measurement data conforming to normal distribution were expressed as mean ± SD, while enumeration data were presented as absolute numbers or percentages. Surgical approaches: defined at the end of surgery; surgical duration: the overall surgical duration, that is, the time period from the patient arriving at the operation preparation room to leaving the anaesthesia recovery room, which included the time of preparation, anaesthesia, operation, and anaesthesia recovery.
Abbreviation: BMI, body mass index.
Based on the patient MAP, which was measured every 5 min throughout all surgeries.
3.2. Comparison of IAPI incidence between two groups
In the experimental group, 2 of 100 patients suffered from IAPIs, while the figure changed to 10 of 100 in the control group. The control group had a higher IAPI incidence than the experimental group (10% vs. 2%, p = 0.017). Moreover, 2 (100%) patients in the experimental group experienced stage‐I IAPIs; while 8 (80%) patients in the control group had stage‐I IAPIs and 2 (20%) underwent stage‐II IAPIs. In terms of IAPI staging, there was no significant difference between the two groups (p = 0.488) (Table 3).
TABLE 3.
Comparisons of IAPI incidence and ΔT on sacrococcygeal skin between two groups.
| Experimental group (n = 100) | Control group (n = 100) | χ2 | p‐Value | |
|---|---|---|---|---|
| IAPI incidence (n (%)) | 2 (4) | 10 (10) | 2.382 | 0.017 |
| ΔT of the sacrococcygeal skin (°C) | 0 (−0.1, 0.1) | 0.2 (−0.2, 0.4) | 0.004 |
Note: Measurement data of skewed distribution were exhibited as M (P25, P75), while enumeration data were shown as absolute numbers or percentages.
3.3. Comparison of ΔT on the sacrococcygeal skin between two groups
The ΔT value on the sacrococcygeal skin of experimental group patients was 0 (−0.1, 0.1)°C, lower than that of control group patients [0.2 (−0.2, 0.4)°C]. The difference was statistically significant (p = 0.004). For patients without PIs from both groups, the ΔT values on the sacrococcygeal skin were concentrated at around 0°C. While among the 12 patients with PIs, 9 (75%) presented with positive ΔT values and 3 (25%) had negative ΔT values. The three patients experiencing stage‐II PIs all exhibited a ΔT value of 0.5°C.
3.4. Comparison of job satisfaction of nurses between two groups
The job satisfaction level of nurses responsible for experimental group patients was 80%, which was reduced to 66% among those caring for control group patients (χ2 = 4.972, p = 0.026) (Table 4).
TABLE 4.
Comparison of job satisfaction of nurses between two groups.
| Groups | Case number | Extremely satisfactory n (%) | Satisfactory n (%) | Unsatisfactory n (%) | Satisfaction (%) | χ2 | p‐Value |
|---|---|---|---|---|---|---|---|
| Control group | 100 | 43 (34) | 23 (23) | 34 (34) | 66 (66) | 4.972 | 0.026 |
| Experimental group | 100 | 54 (54) | 26 (26) | 20 (20) | 80 (66) |
The satisfaction survey is divided into three levels: extremely satisfactory, satisfactory, unsatisfactory, and satisfaction.
4. DISCUSSION
The present research delved into the clinical efficacy of “micromovement” in preventing IAPIs during supine surgery, and found that “micromovement” could lower the incidence of IAPIs to 1/5 of the incidence under conventional approaches. By measuring the temperature differences between the pressure‐bearing site and surrounding area with a non‐contact infrared thermometer, it was discovered that the ΔT values on the sacrococcygeal skin among patients without PIs were concentrated at around 0°C, and that 75% of the patients with PIs had positive ΔT values. Furthermore, although the PI prevention protocol of “micromovement” added to the workload of nurses, their satisfaction level on IAPI prevention‐related work went up from 66% to 80%.
4.1. Pathogenesis of IAPI
The development of IAPIs is a complicated process that involves multiple factors such as anaesthesia grading, BMI, preoperative limb mobility, skin conditions of the pressure‐bearing site, support surfaces, intraoperative blood pressure, body temperature, bleeding volume, and surgical duration. 13 Among all the factors, vertical pressure is the direct trigger of PI development. On the one hand, localized tissue cells are subjected to the traction brought by prolonged and sustained pressure, leading to cell morphological and structural changes. While on the other hand, when local tissues underwent the vertical pressure that is higher than the normal capillary pressure of 16–32 mmHg for a long time, local blood flow may be blocked, resulting in microcirculatory disorders in the pressure‐bearing tissues or organs, ischemic–hypoxic injuries, and finally the development of PIs. 7 Besides, ischemia–reperfusion (I/R) has been proven to be the crucial mechanism underlying the development of PIs. As the blood flow is restored after a period of ischemia in the pressure‐bearing tissues, a cascade of progressively amplified injury reactions is induced by the aggregation of neutrophils and macrophages, massive release of inflammatory factors and oxygen radicals, and calcium overload, culminating in irreversible cell injuries, that is, reperfusion injuries. 14 An animal experiment revealed that 2‐h pressure on local skin led to the reduction of blood flow by 80%, and that 10‐h sustained pressure contributed to injuries in 8% rat tissues. 15 Another clinical trial indicated that the surgical duration of >6 h was an independent risk factor for PI development. 16 It was found that every 0.5‐h extension of the surgical duration was associated with a 33% increased risk of PI development in surgery lasting over 4 h. Additionally, the sites of force of patients in the supine position include occiput, scapula, sacrococcyx, and heels. The incidence of IAPIs in the sacrococcyx exceeds 85%. 17
4.2. “Micromovement” reducing IAPI incidence among patients undergoing surgery in supine position
IAPI prevention is a priority for intraoperative nursing. For patients in the wards, pressure can be reduced and PIs can be effectively prevented via regular repositioning. In contrast, the body position of patients undergoing surgery should be fixed, which results in excessively long local pressure duration. This is the greatest difficulty of IAPI prevention. As the surgical duration increases, the duration of pressure on the skin and corresponding tissues is also extended. As a result, local tissue blood flow decreases, which enhances anaerobic metabolism and aggravates tissue hypoxia, thereby increasing the risk of IAPI development. 17 In this context, clinical practice guidelines have emphasized the PI prevention principle: to minimize the pressure at all bony protuberances and redistribute the pressure to the maximum extent. Nevertheless, the conventional support surfaces of gel pads, cotton pads, and foam dressing are only able to relieve pressure by enlarging the force area, and cannot be used for pressure redistribution. The use of pressure‐relieving mattress decreased IAPI incidence in cardiac surgery by redistributing sacrococcygeal pressure through the alternate deflation of air pouches. 6 Besides, the alternating pressure gel mattress has been found to be able to reduce the interface pressure, thus lowering the risk of PI development. 18 Position changes, that is, repositioning, refers to the movement of patient body. Through repositioning, pressure and shear force can be redistributed, thereby effectively preventing the prolonged and sustained pressure on the sites of force. 10 The lateral position with the head position remaining normal can effectively prevent sacral and occipital PIs. This body position can also help prevent endotracheal tube displacement for patients subjected to tracheal intubation in surgery or intensive care units (ICUs). 19
The current study aimed to explore the effects of surgical table “micromovement” during supine surgery in redistributing sacrococcygeal pressure and reducing IAPI incidence. The International Association of Operating Room Nurses (AORN) has recommended that the body position should be changed every 2 h without interfering with the surgery. 20 However, it is difficult to change the body position regularly in surgery due to surgical field exposure and sterile requirements. The optimal PI prevention scheme for the relieving of tissue pressure is to reposition at least once every 2 h, with the pressure relieving duration lasting at least 15 min each time. 21 With pressure‐relieving mattress, the repositioning frequency can be prolonged to 4 h without impairing PI prevention effects. As for the lateral recumbent position, patients should turn over to a 30° lateral position to minimize the interface pressure on the skin. 10 While in our investigation, the inherent function of operating tables was utilized to make patients experience “micromovement” once every 1 h intraoperatively. To avoid the disturbances of “micromovement” on operators, the tilt angle was set within 15° and each pressure‐relieving duration was set at 5 min. Every time, the “micromovement” protocol was carried out after adequate communication with operators. In essence, “micromovement” refers to slight repositioning. We have found that “micromovement” can significantly decrease sacrococcygeal IAPI incidence among patients undergoing surgery in supine position. Through the pressure redistribution on sites of force, “micromovement” attenuates the sustained vertical pressure on the sacrococcygeal region, thus preventing the obstruction of blood circulation due to prolonged local pressure. In this way, the pathogenesis is obstructed, contributing to the lower incidence of IAPIs.
4.3. Skin temperature and IAPIs
Skin surface temperature is a skin tolerability‐related intrinsic factor that is associated with PI development. 24–96 h prior to PI occurrence, the skin surface temperature increased by 1.28°C. Skin temperature is not only the early warning indicator of PI occurrence, 9 but also a predictor of the efficacy of PI treatment. 22 The ΔT on skin surfaces of normal tissues is about 0°C. 6 In the current study, the ΔT between sacrococcygeal skin and the surrounding areas among patients without IAPIs was around 0°C, and among the 12 patients with PIs, 9 of them had positive ΔT values. The findings were consistent with previous conclusions. 6 Various skin injuries may substantially impair skin blood flow, thereby affecting skin temperature. 21 Higher body temperature is associated with inflammation, while hypothermia can be attributed to malperfusion. 22 The effect on reactive congestion (an indicator of ischemia) for every 1°C increase in skin temperature equals an 8–15 mmHg rise in skin interface pressure. 23 Besides, keeping the supine position for 1 h can lead to a 3°C increase in skin temperature. 24 In this investigation, no patient presented with a ΔT value of over 3°C, and the highest ΔT value was 0.5°C. This might be caused by factors such as subjects, environmental temperature, and the anaesthesia status.
4.4. Blood pressure IAPIs
Several intrinsic and extrinsic risk factors for IAPIs already have been identified in patients undergoing surgery. 25 Undoubtedly, previous studies have shown that the use of vasoconstrictors such as norepinephrine and vasopressin plays a crucial role in the occurrence of PI, as these drugs promote peripheral vascular contraction and may lead to peripheral tissue ischemia. 26 , 27 Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, MAP <60 mmHg in patients receiving vasopressors was predictive of development of pressure ulcers. 27 The recent study validated again that use of vasoconstrictors was one of significant risk factors for heel PI in cardiovascular ICU patients. 28 While in patients undergoing urologic surgery, the total time of diastolic blood pressure <50 mmHg was found to be significantly associated with IAPI. 8 Our present study showed that the incidence of MAP‐values of less than 65 mmHg was comparable in the two groups. Our current study did not investigate the use of vasoconstrictors. We only investigated the incidence of hypotension and did not investigate the duration of hypotension. Microcirculation disorders caused by low blood pressure or administration of vasoconstrictors, skin vasoconstriction may have adverse effects on IAPI. However, further research is needed to confirm whether there is an interaction between hypotension and systolic blood pressure on the incidence of IAPI.
5. CONCLUSION
The “micromovement” protocol implemented by this study is only applied to supine surgery, but its effect in lateral or prone surgery remains ambiguous. Moreover, the present research is a single‐centre study with a relatively small sample size. Further clinical trials of larger sample sizes are still warranted to confirm our results. In conclusion, the intraoperative “micromovement” protocol can alter the pressure‐bearing sites at the sacrococcygeal region, reduce local skin temperature fluctuations, and improve skin microcirculation. This protocol is able to prevent IAPI while enhancing job satisfaction of nurses, thus providing creative thoughts and practical experience for IAPI prevention among patients undergoing supine surgery in clinical settings.
FUNDING INFORMATION
Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project (2023ZL593); Shaoxing Public Welfare Project (2020A13014); Hangzhou Medical and Health Technology Project (B20210683, B20220840).
CONFLICT OF INTEREST STATEMENT
The authors declare that there is no conflict of interest.
Jin Y‐X, Liu J, Shentu Y‐Q, Xuan F‐F, Guo H, Li Y‐H. Effect of “micromovement” in preventing intraoperative acquired pressure injuries among patients undergoing surgery in supine position. Int Wound J. 2024;21(2):e14408. doi: 10.1111/iwj.14408
Ya‐Xian Jin and Jing Liu are contributed equally to this work
Contributor Information
Hua Guo, Email: hua.guo@shulan.com.
Yu‐Hong Li, Email: yuh_li@zju.edu.cn.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.