Table 1.

Medical Care Facilities and Their Use of Support Surfaces for Myocutaneous Flaps, Grafts, and Complex Wounds

Hospital	Surface Used for Flaps or Grafts	Comments
CHRISTUS Schumpert, Shreveport, LA	Low air loss	1. So many of our patients also have pulmonary problems that the air flotation bed is simply not feasible (the small particles of silicone can become airborne and create breathing difficulties for those with pulmonary problems). 2. The air-fluidized beds are difficult for staff to manage and turn patients on, and there is a risk of patients' ending up lying on a very hard, deflated surface for several hours when the staff does not know how to deal with an infrequently used bed.
Avera McKennan Hospital, Sioux Falls, SD	Low air loss	We use very few air-fluidized beds (475-bed hospital). We use low air loss for the first 3 weeks postflap, less (if at all) for grafts, and haven't seen a big difference in the “take.”
Levindale Hebrew Geriatric Center and Hospital, Baltimore, MD	Continuous lateral rotation with low air loss	We found that many patients with stage IV on the buttocks healed better on low-air-loss rotation beds.
Skyline Medical Center, Nashville, TN	Low air loss	Colleagues in plastic surgery feel that this surface provides adequate pressure redistribution during the bedrest phase of healing as they believe the primary reason for flap failure is allowing the patient to sit too soon. We have not seen any decrease in flap take with use of the low-air-loss support surface.
CHRISTUS Spohn Hospital, Corpus Christi, TX	Alternating pressure	Therapeutic advanced nonpowered for prevention in high-risk, alternating pressure for flap or graft.
Rutland Regional Medical Center, and Rutland Area Visiting Nurses and Hospice, Rutland, VT	Low air loss	Rental of air-fluidized therapy equipment is very rare, but it does happen, for example a very compromised patient in a very compromised environment. It is apparent that the surface should be matched not only with the criteria of provision but also with the person's personality, medical history, and medication regime.
Shepherd Center, Atlanta, GA	Low air loss	We use air fluidized when there are other ulcers, reducing our turning surfaces, and to reduce moisture around the flap. We use alternating pressure mattress when there are 1 or 2 turning surfaces available.
Swedish Hospital, Craig Hospital, Denver, CO	Low air loss or combination of low air loss and alternating pressure	We found that the air-fluidized beds are so debilitating, they do not serve as good pulmonary beds, and most of our quads and paras ended up with hospital-acquired pneumonias or having to be vented. The flap does great on the fluidized bed, but the side effects for the patient, including depression, new breakdown on upper back from transition, and pneumonias, outweighed the bed. We switched to a low-air-loss mattress or a combination of a low-air-loss and an alternating-pressure mattress and have done very well.