Why are donuts not beneficial for patients with pressure ulcers?

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Last updated: August 19, 2026 • View editorial policy

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Donut Cushions Are Harmful for Pressure Wounds

Donut-shaped cushions should never be used for patients with existing pressure ulcers because they concentrate pressure on the surrounding tissue, create a ring of ischemia around the wound edges, impede blood flow to the healing area, and can actually worsen the ulcer or prevent healing.

Why Donuts Fail: The Mechanism of Harm

While the provided guidelines don't explicitly address donut cushions for pressure ulcer treatment, the fundamental principles of pressure ulcer management make their harm clear:

Pressure Redistribution vs. Pressure Concentration

  • Evidence-based treatment requires pressure redistribution across the entire surface area 1
  • Donut cushions do the opposite—they create a ring of concentrated pressure around the wound perimeter
  • This ring effect causes tissue ischemia in the exact area that needs maximum blood flow for healing
  • The center "relief" is meaningless when you've created a tourniquet effect around the wound edges

What Actually Works for Treatment

The 2015 ACP guidelines provide clear evidence-based recommendations 1:

Support Surfaces:

  • Air-fluidized beds were superior to standard surfaces for reducing wound size
  • Advanced static mattresses or foam overlays that redistribute pressure across the entire body surface
  • Low-air-loss mattresses provide continuous pressure redistribution

Wound Dressings:

  • Hydrocolloid or foam dressings to reduce wound size (weak recommendation, low-quality evidence) 1
  • These are superior to gauze dressings

Nutritional Support:

  • Protein or amino acid supplementation to reduce wound size (weak recommendation, low-quality evidence) 1

Adjunctive Therapy:

  • Electrical stimulation to accelerate healing of stage 2-4 ulcers (weak recommendation, moderate-quality evidence) 1

The Prevention Context: A Critical Distinction

One study examined donut cushions for prevention during cardiac surgery in patients without existing ulcers 2. This is fundamentally different from treating established pressure wounds. Even in that prevention context, the study showed no statistical benefit, though it was underpowered.

Common Pitfalls to Avoid

  1. Never confuse prevention strategies with treatment strategies—what might theoretically help prevent pressure in intact skin can devastate healing tissue
  2. Avoid any device that creates focal pressure points around wound margins
  3. Don't use ring cushions, inflatable donuts, or any circular pressure-relief device for existing ulcers

The Bottom Line

For pressure ulcer treatment, use full-surface pressure redistribution (air-fluidized beds or advanced static mattresses), appropriate wound dressings (hydrocolloid or foam), protein supplementation, and consider electrical stimulation as adjunctive therapy 1. Donut cushions violate the fundamental principle of pressure redistribution and create a ring of ischemia that impairs healing.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.