Abstract:
A support system including a cushion or pad having a foam core and cover is disclosed. The support system is capable of taking a variety of different shapes and can be adjusted for firmness. The support system may be used during and after surgery and more generally, any time when it is desirable to utilize a sterilizable, adjustable cushion. Additionally, multiple cushions may be used in a variety of combinations at any one time.

Description:
RELATED APPLICATION 
     The present application claims the benefit of U.S. Provisional Application No. 60/841,034 filed Aug. 30, 2006, entitled “Positioning System for Use in a Perioperative Environment” which is incorporated herein in its entirety by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to the field of medical positioning systems including pads and cushions that are used in a perioperative environment. 
     BACKGROUND OF THE INVENTION 
     The perioperative environment includes surgical operating rooms and related areas of hospitals and surgical centers. The perioperative environment includes but is not limited to: the operating room, one day surgery areas, trauma units, critical care areas, plastic surgery, neonatal intensive care, patient transportation, obstetrics, the post anesthesia care unit, radiology, X-ray, the electrophysiology lab, nursing services and the neonatal care unit. 
     During surgery, a patient may spend a great deal of time lying on a 20 inch wide surgical bed table where the patient is positioned by various devices, pads and cushions. Generally, hospitals provide fairly crude positioning devices for this positioning process. For example, patients may be propped into a selected operative position by rolled-up sections of bath blankets, disposable foam and surgical towels. However, these fairly crude positioning devices do not provide an acceptable degree of stability and do not facilitate appropriate safety as noted by the Association of Operating Room Nurses (A.O.R.N.). 
     Furthermore, for example, a rolled bath blanket used for a chest roll in the prone position can create peak pressure points that may cause capillary occlusion. A restriction of blood flow or capillary occlusion can cause post-operative decubitus ulcers and hence can require a long term costly physical therapy regimen. In addition, high interface pressure can lead to localized nerve damage, tissue damage or damage to muscles and bones. 
     The most common post-operative injuries are decubitus ulcers, also known as bed sores or pressure sores. Decubitus ulcers are wounds that form due to prolonged pressure on a particular point on the body, which constricts blood flow. Such pressure sores may result from a positioning device that creates high pressure (over 32 mmHg) against the skin. Once formed, pressure sores can take months to heal and can actually become life-threatening. The average cost to treat one Stage II decubitus wound is $40,000 to $50,000, according to the National Wound Care Association. 
     It is estimated that 23-25% of post-operative decubitus ulcers arise from damage that initially occurs due to high interface pressure on a specific area on the skin that occurs during surgery. The risk of decubitus ulcer development increases in patients that are prone to reduced circulation such as diabetics and the elderly. Decubitus ulcers lead to increased costs for medical care as well as increased cost that arises from potential medical malpractice claims; estimates of cost for this type of post-operative injury totals $2-$10 billion dollars per year. 
     Pressure ulcers may be a complication of immobility. The major cause of pressure ulcers is generally accepted to be an external pressure that occludes blood vessels (capillary occlusion). 
     Two distinct mechanical forces that contribute to pressure ulcers are a direct downward pressure and shear pressure. 
     Tissue Interface Pressure (TIP) is a direct downward vertical pressure, can occlude blood capillaries and cause ischemia to the area supplied by the affected vessels. Prolonged ischemia leads to cell and tissue death. 
     Shear Pressure is a horizontal force that occurs when the skin and underlying subcutaneous tissues are pulled taut and over-stretched, causing tissue deformity, obstructing blood flow and tissue necrosis. 
     Pressure and Shear will be higher in areas where soft tissue lies over bony surfaces. Forces over bony prominences should be reduced whenever possible. 
     Surgical procedures of greater than two hours and procedures that involve the cardiovascular system may cause an otherwise low risk patient to be at risk for harm. Patient positioning in surgery in general needs to be assessed carefully and surfaces used in positioning should meet recommended A.O.R.N. standards for positioning. 
     Positioning products commonly used by hospitals today include: 
     1. Reusable surgical towels. 
     2. Reusable bath blankets. 
     3. Disposable foam pads. 
     4. 2″ stitched surgical table pad. 
     5. Stitched, dipped and sprayed foam products. 
     6. Sheets, pillow cases and stitched pillows. 
     7. Various gel pads. 
     8. Rolled towels, sheets or bath blankets, often held with tape. 
     None of the presently used positioning products has been recommended as clinically sound for the positioning the patient by the U.S. A.O.R.N. (Association of Operating Room Nurses). In 2002, the A.O.R.N. declared positioning as a major safety concern in the perioperative environment. 
     Consequently, various cushioning devices or pillows have been developed for use in the medical field to alleviate dangers caused by rolled bath blankets, for example. Typical pillows or cushions are designed to provide support for a particular body part and have most often been produced for the following specific body parts: neck, head, foot and heels, sacral, trochanter, brachial plexus, and major surgical positions (supine, prone, lateral, Fowler and lithotomy). To provide such support, these cushions are sometimes constructed and designed to conform to the shape of the body part to be supported, too often with non-standard, inappropriate materials that are not tested for safe pressure outcomes, nor approved by the A.O.R.N for safe clinical practices. 
     Conventional stitched pillows are usually filled with a cushioning material of synthetic polyester, fiberfill or foam. Such pillows can be manipulated to conform to the shape of the body part to be supported. If the construction of the pillow is too firm, however, it becomes difficult to adjust the shape of the pillow to the body part. Conversely, if the pillow is too soft, depressions are easily formed, and the proper safe pressure of the body member is not achieved. Furthermore, the shaping capabilities of such conventional pillows are rather limited. Often, the filler simply packs into a dense mass and loses its resiliency. These positioners traditionally have stitched seams with rough edges that are exposed to the patient&#39;s skin, and thus also support the potential for cross-contamination after each use. Cross contamination can occur when pathogens such as bacteria or bodily fluids such as blood are trapped in the stitched seams or the thread itself. These products are cleaned and disinfected between surgical cases with low grade antimicrobials and are often used again for another procedure on another patient within fifteen minutes. 
     In response to the deficiencies of conventional filling material, inflatable cushions or pads have been developed. However, most of the prior inflatable pad cushions are very complicated structures that are costly to manufacture. Additionally, the prior inflatable cushions may be too firm, so pressure points and bed sores may still occur. Prior art inflatable cushions often also have stitched seams that may create pressure points and that may harbor pathogens. 
     Foam cushions may also create pressure points because the positioning cushions ‘bottom out’ due to inappropriate foam being used in combination with the correct foam thickness. 
     Accordingly, there exists a need in the art for improved positioning pads or cushions that are economical to use and that help reduce the potential for post-operative injury by providing safe interface pressures. Furthermore, there exists a need for such a pillow to be easily shaped or conformed to the desired configuration to provide support, while retaining sufficient resiliency to maintain the desired shape until it is intentionally changed by the user. 
     SUMMARY OF THE INVENTION 
     An improved support system and associated methods of preventing adverse health risks associated with surgery, such as pressure points and bed sores is described herein. The invention, in one embodiment, includes a 4″ thick fluid-proof, conformable fabric cushion or surgical table pad having a foam core and conformable fabric cover. The cushions or pads optionally also includes a valve, which permits the passage of a fluid (i.e., air) into and/or out of the cushion. Because the amount of air in the cushion is adjustable, the present support system is easily shaped to the desired configuration to provide support for the patient, while retaining sufficient resiliency to maintain the desired shape until it is intentionally changed by the user. In one aspect, the present invention is adjustable to avoid high interface pressure points particularly during long term surgical procedures (over 2 hours). Pressure adjustment can be accomplished in a localized area, such as the patient&#39;s torso, to reduce the risk of pressure induced ischemia that may lead to decubitus ulcers, as well as post-operative nerve and muscle damage. 
     Generally, the present invention relates to the field of medical perioperative positioning and specifically to a standardized system of surgical table pads, stretcher pads, and related body positioning pads for protecting and stabilizing the patient in the perioperative environment by providing appropriate pads that conform to the bony prominences, while in doing so, providing reduced ‘interface pressure’ that helps protect the patient during the procedures while on the surgical table and reduce the post-operative trauma of skin, nerve and muscle damage. 
     The reusable surgical positioner system may be used to accommodate all perioperative surgical procedure positions—primarily the supine, prone, lateral, Fowler and lithotomy positions, and all modified positions related to these primary positions in surgery. For example, the invention may include a three piece surgical table pad, a stretcher pad and/or body positioning pads. 
     In one aspect, the reusable system of the invention has includes:
         1. A conformable reusable outer fabric covering which is, fluid-proof and bacteria resistant. The fabric covering may exhibit Cytotoxicity and be tested for skin sensitization. The fabric is durable to allow for repeated usage and may be cleaned with normal hospital anti-microbial cleaning agents.   2. The fabric cover may be formed with Radio Frequency (RF) or similar welded seam on all pads and positioner products in the system that inhibit cross-contamination between procedures by eliminating stitched seams. Cross contamination is inhibited in part because the products in the system are fluid-proof and may be treated to be antibacterial.   3. Some embodiments include an air release valve for allowing air to be released during the procedure while the patient is on the pad/positioner. The valve allows air to be released, adjusting for the patient&#39;s weight while on the pad/positioner, thus providing a reduction of peak interface pressure on the primary bony prominences such as heel, trochanter, sacrum, ischium, brachial plexus, shoulder blade, elbow and head.       

     The table pad/positioner also facilitates stabilizing the patient on the surgical table during the procedure, thus providing and supporting a positive post-operative outcome by reducing the incidence of post-operative injury associated with inappropriate positioning devices presently commonly used in all United States health care hospitals. 
     The system of positioners is reusable and thus provides a strong economic benefit to the managers of the perioperative environment. 
     The reusable positioning system provides a comprehensive offering of positioning products with configured foam pads, covered with a conformable, fluid-proof, stretchable polyurethane fabric, RF welded that provides a system of products that can be reused by the surgical environment, and thus providing benefits in
         Major cost reduction to the health care facility, and   Strong potential benefit of reduction of interface pressure which help reduce tissue, nerve and muscle damage       

     The positioning system helps reduce pressure under the patient&#39;s positioned body area by releasing air from the RF welded pad through a valve which is electronically welded into the positioning device—such as a torso pad of a surgical table, a chest roll under a patient in a prone position, or a foot and heel pad under a patient&#39;s foot in a supine position on a surgical table. The positioner pads are all made of the same tested material thus creating a standard material application for each patient. 
     One aspect of the present invention includes a surgical table pad set adaptable for all tables in a variety of configurations, usually 3 to 5 pieces—head, torso, foot and 2 armboards. 
     An example surgical table pad includes:
         1. A 4″ height   2. A fluid-proof seam, RF welded or electronically or heat welded   3. A fluid-proof cover   4. A series of Velcro attachments to limit slippage on O.R. table. The attachments are located at the base of the pad—as needed   5. A conformable stretchable fabric   6. A foam inner core—having a variety of foam densities       

     Regarding pressure reduction for a patient during surgery, one embodiment of the pad includes an air valve release that allows air to be released from the RF welded fabric envelop and thus reduces the interface pressure between the surface of the pad and the key pressure points of the patient thus more evenly distributing the weight of the patient over the surface of the pad. This allows the patient to better tolerate long and short surgical procedures. This helps to reduce the occurrence of post-operative injury, primarily tissue damage and nerve damage. 
     As the patient is positioned with a positioning pad within the system, the valve may or may not be opened based on the length of the procedure and other factors. If the procedure is short (less than 1 hour), the surgical staff may leave the valve closed, as the configuration of the pad (enclosed foam) and outer fluid-proof conformable cover will provide immediate pressure reduction in concert with the soft layers of foam. If the procedure is longer (over 2 hours) or if a patient is clinically compromised, the valve is rotated opening the airway to the inner core of the pad. As the air is released, the inner foam core adjusts to the weight of the patient, and reduces the pressure load on the most significant bony prominences, which helps distribute the total body weight so the surgical/perioperative patient can tolerate the procedures without serious concern for tissue or nerve damage. This is safety feature and benefit built into the positioner system that creates a new standard for safety in all surgical patient procedures in the United States versus the variety of textile and stitched products now commonly used in the perioperative environment. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of a positioning system pad in accordance with an embodiment of the invention. 
         FIG. 2  is a perspective view of a positioning system pad in accordance with an embodiment of the invention. 
         FIG. 3  is a perspective view of a positioning system pad in accordance with an embodiment of the invention. 
         FIG. 4  is a perspective view of a positioning system pad in accordance with an embodiment of the invention. 
         FIG. 5  is a perspective view of a positioning system pad in accordance with an embodiment of the invention. 
         FIG. 6  is a cross-sectional depiction of a head section in accordance with the present invention. 
         FIG. 7  is a sectional view of a torso section in accordance with the present invention. 
         FIG. 8  is a sectional view of an example foot section in accordance with the present invention. 
         FIG. 9  is perspective view of a set of surgical table pads in accordance with the present invention. 
         FIG. 10  is a plan view of the set of surgical table pads of claim  9 . 
         FIG. 11  is a perspective view on an arm board pad in accordance with the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     Referring initially to  FIG. 1 , a positioning system  10  in accordance with the invention includes at least one pad, cushion or pillow  12  that is constructed from a foam core (not shown) and a cover  26 . Exemplary cushion  12  includes two elliptical or circular shaped ends  14 ,  16  and an oblong shaped body portion  18 . Positioning system pads may include operating room table pads, stretcher pads and positioning pads. 
     In one embodiment, valve  20  is located on or within elliptical end  14 . Valve  20  is not limited to this location, however, and may be located on or within any suitable surface of cushion  12  including oblong body portion  18 . 
     Valve  20  is generally a lid, plug, or cover  22  applied to an aperture (not shown) so that by its movement, as by swinging, lifting and falling, sliding, turning, etc., valve  20  will open or close the aperture to permit or prevent passage of a fluid (not shown) such as air. The form of valve  20  is not particularly important so long as it can be opened and sealed as desired to release air from a pad under compression or to allow air to return into a pad not under compression. 
     In some embodiments, valve  20  includes a check valve assembly (not shown) that prevents the flow of air when valve  20  is in its default position. By manipulating valve  20 , such as by squeezing valve  20 , the check valve is able to open to allow the passage of air. 
     In an alternate embodiment, valve  20  includes a removable check valve assembly (not shown). The check valve operates primarily as a conventional check valve and allows air to be introduced into cushion  12 , but does not allow air out of cushion  12 . When a user desires to release air from cushion  12 , the check valve is simply removed by the user. 
     While valve  20  has been described thus far as including a check valve or check valve assembly, valve  20  may alternately include a clack valve, a screw valve, or a slide valve. Furthermore, in some embodiments, the air controlling device is internal to cushion  12  and thereby allows cushion  12  to self-inflate or self-deflate. 
     The foam core may be an open cell foam material selected from the group including, but not limited to, polyurethane, polyimide, and melamine. The foam core may take any shape, depending on the purpose of the shape of cushion  12  within positioning system  10 . For example, referring still to  FIG. 1 , the foam core is the same general shape depicted by cushion  12 . 
     Additionally, the foam core may be selected based on the compression modulus of the foam itself. In some embodiments, the compression modulus of the foam is less than 2.0. In still other embodiments, the compression modulus is less than 1.6. Compression modulus is generally defined as the ratio of a foam&#39;s ability to support force at different indentation or compression levels. Compression modulus is determined by taking the ratio of a foam&#39;s indentation force deflection (IFD) at 25% IFD and 65% IFD. 
     In one aspect of the invention, cover  26  is a moisture impermeable medical grade material selected from the group including, but not limited to: penn nylla, polyvinylchloride (PVC), polyurethanes, polyolefins, nylon, polyethylene terephthalate (PET), ethylene vinyl acetate (EVA), and acrylonitrile butadiene styrene (ABS). 
     In some embodiments, cover  26  may be formed from a conformable stretchable fabric that reduces high interface pressure. For example, it is preferable for the interface pressure on the skin of a patient to be at or below around 32 mm Hg. Interface pressure is herein defined as the highest pressure at which a capillary can remain open and sustain blood flow. In one aspect of the invention, Lycra-like fabrics may be used. 
     Cover  26  (and consequently cushion  12 ) are fluid impermeable water-proof and durable enough to withstand hospital cleaning disinfecting solutions. 
     In one embodiment, cover  26  is formed by radio frequency (“RF”) welding its seams together. Radio frequency welding is the process of fusing materials together by applying radio frequency energy to the area to be joined, i.e. a seam. The resulting seam is impervious to fluids because, unlike stitched seams, no needle holes are created from the weld. Consequently, a benefit of RF welding is that the resulting weld can be as strong as the original materials. In addition, ultrasonic welding or heat sealing may be utilized. 
     The relationship between the foam core and cover  26  may vary, depending on the intended use of cushion  12  of positioning system  10 . For example, in some embodiments, cover  26  fits snugly over the foam core. In such embodiments, cover  26  may or may not be connected to the foam core. Also, in the embodiment of  FIG. 1 , the height H, width and length (not shown) of cushion  12  are approximately the same dimensions as that of the foam core. 
     In alternate embodiments, cover  26  fits loosely over the foam core. While cover  26  may be connected to the foam core in such embodiments, more likely than not cover  26  will not be connected to the foam core. Because the amount of air within cushion  12  is adjustable, its height H, width and length (not shown) are variable, depending on the amount of air in cushion  12  and the height of the foam core. Additionally, the shape of cushion  12  depends on how pressure from a user is placed on cushion  12 . For example, when cushion  12  is uncompressed, it will resemble the shape of the inflated cover  26 . Alternately, when cushion  12  is barely inflated, it will resemble the shape of the foam core. Therefore, cushion  12  is easily shaped to the desired configuration to provide desired support and firmness, while retaining sufficient resiliency to maintain the desired firmness until it is changed by the user. 
     A problem with prior positioning systems is that in many instances, the amount of air in a cushion when compressed by the patient&#39;s body weight at ambient pressure is too great, making the pad too firm. A benefit of positioning system  10  is that the user may release air from of cushion  12  via valve  20 , thereby decreasing the volume and firmness of cushion  12 . This release of air reduces interface pressure and may decrease the likelihood of patients developing pressure points and bed sores. Furthermore, this release of air assists in maintaining an interface pressure of less than about 32 mm Hg. 
     Referring now to  FIG. 2 , positioning system  110  in accordance with another embodiment includes a cushion  112  and a foam core (not shown). Cushion  112  includes two semi-circular shaped ends  114 ,  116 , and a U-shaped body  122 . It should be noted that U-shaped body  122  and semi-circular ends  114 ,  116  generally constitute one continuous structure, i.e. cushion  112 . For example, an embodiment depicted in  FIG. 2  may be four inches high and include RF welded seams 
     U-shaped body  122  includes an outer surface  118  and an inner surface  120 . Outer surface  118  includes two elongated side portions  126 ,  128  and a back portion  130 . Elongated side portions preferably extend from back portion  130  to semi-circular ends  116 ,  114 . In one embodiment, two curved corner portions  132 ,  134  provide a transition between side portions  126 ,  128  and back portion  130 . 
     Similarly, inner surface  120  includes a U-shaped back portion  140  and two side portions  142 ,  144 . Side portions  142 ,  144  preferably extend from back portion  140  to semi-circular ends  116 ,  114 . 
     In one embodiment, valve  150  is located on or within semi-circular end  116  or  114 . In alternate embodiments, valve  150  may be located on or within outer surface  118 , inner surface  120 , or other suitable surfaces of U-shaped body  122 . Similar to valve  20 , valve  150  provides a means for permitting or preventing passage of air into or out of cushion  112 . 
     Referring now to  FIG. 3 , a positioning system  210  in accordance with a further embodiment is shown including cushion  212  having a foam core (not shown). Cushion  212  includes a semi-cylindrical shaped first body portion  214  and a generally square or rectangular shaped hexahedral second body portion  216 . Rectangular shaped body portion  216  preferably includes five sides with semi-cylindrical shaped body portion  214  functioning as its sixth side. 
     In one embodiment, a valve  220  is located on or within a front side  222  of rectangular body portion  216 . In alternate embodiments, valve  220  may be located on or within other surfaces of rectangular body portion  216  or on or within surfaces of semi-cylindrical body portion  214 . 
     While positioning system  210  is shown with first body portion  214  and second body portion  216  as part of one continuous body  226  where one valve  220  is necessary to inflate/deflate continuous body  226 , it is contemplated that first body portion  214  and second body portion  216  make up separate, non-continuous bodies (not shown). In such embodiments, at least two valves  220  may be necessary to control air release in the separate bodies, providing additional positioning or cushioning options. For example, the embodiment depicted in  FIG. 3  may include an adult chest roll twenty inches long, five inches high and six inches wide with a rounded top portion having RF welded seams. 
     Referring now to  FIG. 4 , a positioning system  310  in accordance with an additional embodiment is shown including a cushion  312  having a foam core (not shown). Cushion  312  is preferably a generally square or rectangular shaped hexahedron  314 . In some embodiments, the length L and width W of hexahedron  314  are at least twice as great as height H. In other embodiments, the values of length L, width W, and height H vary considerably. Various embodiments may include hook and loop straps. 
     Similar to other embodiments, cushion  312  includes a valve  320 . As shown in  FIG. 4 , valve  320  is located on or within front side  322  of hexahedron  314 . In alternate embodiments, valve  320  may be located on or within other surfaces of hexahedron  314 . 
     Referring now to  FIG. 5 , a positioning system  410  in accordance with another embodiment is shown including a cushion  412  and a foam core (not shown). Cushion  412  is preferably shaped like a ring or donut  414  and includes valve  420 . Similar to previous embodiments, valve  420  may be located on or within any surface of donut  414  and valve  420  provides a means for permitting or preventing passage of air into or out of cushion  412 . 
     Other suitable design shapes for aspects of positioning system  10  include, but are not limited to, cushions shaped like a wedge, a rectangle or rectangular hexahedron having grooves extending across the surface, a circular ring, a roll (similar to positioning system  110 ), and a square or square hexahedron having an empty circular core. For further examples of cushion shapes, see Appendix B, incorporated herein by reference. 
     Optional features that may be present on any portion of positioning system  10 ,  110 ,  210 ,  310 , and  420  include flanged edges or seams on the covers. Additionally, the covers may include one or more patterned or non-skid surfaces, so that the positioning systems stay in place. However, surface that make contact with a patient&#39;s skin are desirably formed of stretchable, conformable polyurethane fabric. Further desirable features may also include mechanical fasteners such as hook and loop straps or the like located on the covers so that a user can attach the positioning systems to his hospital bed or person for proper positioning. 
     In use, a medical professional selects one or more appropriate pads from positioning system  10  and places the pads in a desired position under or proximate to a patient&#39;s body. The user places weight on the positioning system by virtue of his or her body or body portion. The medical professional then adjusts the positioning system accordingly; if the positioning system is too firm, the nurse releases air from the pad. The nurse may optionally change the pad out with a more appropriate positioning system or add more pads as needed or desired. 
     In another aspect of the invention, a surgical table pad  422  and stretcher pad  423  are a part of surgical positioning system  10 . Referring to  FIGS. 6-11 , the surgical table pad  422  includes a variety of configurations usually including three to five parts. Generally, surgical table pad  422  includes head pad  424 , torso pad  426 , foot pad  428  and two arm board pads  430 . 
     The surgical table pad of the present invention is at least four inches thick, which is substantially thicker than the more commonly available two inch thickness surgical table pads. The surgical table pad  422  further includes a fluid impermeable cover that has seams  432  which are sealed by Radio Frequency welding, electronic or heat welding. Surgical table pad  422  further includes a series of Velcro attachments (not shown) to stop slippage on the operating room table. The attachments, in one aspect of the invention, are located at the bottom of the base of surgical table pad  422 . The surgical table pad  422  is covered with a stretchable, conformable fabric which has improved tactile qualities for contact with the patient&#39;s skin. The surgical table pad  422  further includes a foam inner core. 
     A three piece surgical table pad  422  system in accordance with the present invention includes at least a head pad  424 , a torso pad  426 , and a foot pad  428 . 
     An example head section  424  is approximately ten inches in length, twenty inches in width and four inches in height for a conventional surgical table. Other surgical tables may vary in size, in particular a bariatric surgical table for exceptionally large patients may substantially larger than these dimensions. 
     The head pad  424  includes an outer foam portion  434 , a soft foam portion  436  and a memory foam portion  438 . As depicted in  FIG. 6  the outer foam portion  434  includes the outer perimeter of the head pad  424 , as well as the base of the head section  424 . The memory foam portion  438  and soft foam portion  436  are formed as an insert into the outer foam portion. 
     An example torso pad  426  will typically be forty to forty-six inches in length, twenty inches in width, and four inches in height. Again, these dimensions may vary depending upon the application. The torso pad  426  also includes a dense outer foam portion  440 , a soft foam portion  442 , and a memory foam portion  444 . In one embodiment, memory foam portion  444  and soft foam portions  442  are overlaid with the soft foam portion  442  beneath the memory foam portion  444  and inset into the dense foam portion  440  of the torso pad  426 . In one example embodiment, the memory foam portion  444  is approximately one-half inch thick and the soft foam portion  442  is approximately one-half inch thick. 
     Referring to  FIG. 7  in one embodiment of the torso pad  422 , the memory foam portion  444 , soft foam portion  442  inset occupies approximately the central fifty percent of the torso section pad by length. This dimension may vary from thirty five to sixty five percent. This allows for lower interface pressure on the lower back and sacral portion of the body, which are a common location for the development of the decubitus ulcers. 
     The torso pad  426  may also include pressure release valve  20  to allow for lowering of interface pressure by release of air from within the torso pad  422 . 
     The foot pad  428  for most surgical tables, in one aspect of the invention, is approximately twenty by twenty four inches or twenty by forty-four inches and four inches thick. In one example embodiment of the invention, the foot pad  428  has a dense foam base  446  and an inset formed of memory foam portion  448  laid over soft foam portion  450 . In one example embodiment, the inset portion is approximately six inches wide, centrally located between two seven inch portions along the twenty inch width of the foot pad  428 . Similar to a previously disclosed embodiment, in one aspect of the invention, the foot pad  428  includes a one-half inch layer of memory foam overlaid over a one-half inch layer of soft foam inset into the dense foam base  446 . 
     In another aspect of the invention, a series of surgical positioning pads include welded fluid proof seams, soft conformable fabric covers and a variety of foam densities distributed throughout the pad. Depending upon the area of use intended, some surgical pads include valves  20  that can open and close and release air to allow more conformability of the positioning pads to the patient. In particular, pads that are used under boney prominences and areas of increased interface pressure with the patient&#39;s body during surgical procedures benefit from having release valves  20  to release pressure within the pads. 
     This ability to adjust interface pressure of the pad on key pressure points of the patient&#39;s body allows the distribution of the weight of the patient over the surface of the pad and further allows the patient to better tolerate long or short surgical procedures while reducing the occurrence of postoperative injury such as the decubitus ulcers, tissue damage and nerve damage. 
     When considering the torso pad  426  of the present invention, the insert foam portion can extend from about thirty-five percent to sixty-five percent of the length of the torso pad  426 . The inset section generally will be located in the central portion of the pad symmetrically to provide for ease of use so that the pad will not be misplaced if it is put on the surgical table with the head end switched with the foot end. In addition, the inset portion will generally occupy approximately the central thirty percent of the width of the surgical table pad. For example, in the foot section, the foam inset including memory foam and soft foam may extend from twenty to forty percent of the width of the foot section pad. 
     Generally, the inset portion will occupy the top twenty-five percent of the thickness of the surgical table pads. In one aspect of the invention, the memory foam portion will occupy ten to fifteen percent of the thickness of the pad and the soft foam portion will occupy from ten to fifteen percent of the thickness of the pad. In one embodiment of the invention, the thickness of the memory foam portion and the soft foam portion are approximately equal, though this should not be considered limiting as other combinations may be used. 
     The present invention may also include a stretcher pad having dimensions of approximately seventy-six inches by twenty-nine inches. The stretcher pad may also have a center inset portion, a foot inset portion and a pressure release valve as discussed above with relation to the surgical table pads. 
     The invention may be embodied in other forms without departing from the spirit of essential attributes thereof; therefore the illustrated embodiments should be considered in all respects as illustrative and not restrictive. For example, while portions of the positioning systems  10 ,  110 ,  210 ,  310  and  410  shown in  FIGS. 1-5  generally constitute a single continuous cushion having one valve, its is contemplated that the positioning systems may constitute a plurality of non-continuous portions having a plurality of valves. 
     Additionally, while various example embodiments of positioning systems are shown in  FIGS. 1-5 , it is contemplated that any combination of portions of positioning systems  10 ,  110 ,  210 ,  310 , and  420  may be used simultaneously to construct additional positioning system arrangements. Furthermore, it should be appreciated that positioning systems  10 ,  110 ,  210 ,  310 , and  420  are example embodiments, and that the positioning systems in accordance with the present invention may take any suitable shape, and not be limited to the shapes shown in the Figures.