By Christos Chapeshis, Gerontologist, CEO of ABeWER. BScN, Dipl. W, Dipl. N, Dipl. CN, RN, CDTT, MScG. Review Article. Last updated: April 2026.
Lateral rotation mattresses support wound healing by continuously repositioning the patient from side to side, reducing sustained pressure on at-risk tissue, limiting shear forces, and restoring capillary blood flow to the skin. Compared with alternating pressure mattresses, which cycle inflation across small air cells under the body, lateral rotation systems deliver larger-scale postural change and an additional benefit for patients with pulmonary complications. Current guidance from EPUAP/NPIAP/PPPIA and clinical observation from the ABeWER multiTURN® 6 program indicate that lateral rotation is most useful in stage 1 to stage 4 pressure injuries where continuous offloading and perfusion restoration are clinically required (EPUAP, 2019; Chapeshis, 2025).
Introduction
Pressure injuries, commonly known as bedsores, pose a significant health risk to individuals with limited mobility. Effective prevention and treatment of these injuries depend on the selection of an appropriate mattress system. Two of the most common therapeutic mattresses used in clinical and home-care settings are lateral rotation mattresses (LRM) and alternating pressure mattresses (APM). This article examines the key differences between these two technologies, their benefits, limitations, and appropriate use cases, with a specific focus on the role of lateral rotation mattresses in wound healing.
Understanding Pressure Injury Prevention and Treatment
Pressure injuries occur due to prolonged pressure on the skin, leading to tissue ischemia and necrosis (Gefen, 2008). Effective interventions, such as specialised support surfaces and stage-specific wound dressing selection, are essential to redistribute pressure, minimise shear forces, and maintain a healing microclimate (European Pressure Ulcer Advisory Panel [EPUAP], 2019). The choice between a lateral rotation mattress and an alternating pressure mattress depends on factors such as patient condition, risk of pressure injuries, stage of existing wounds, and presence of respiratory complications (National Pressure Injury Advisory Panel [NPIAP], 2021).
Lateral Rotation Mattress (LRM)
Mechanism of Action
A lateral rotation mattress works by rotating the patient laterally, typically up to 40 degrees from side to side at predetermined intervals. This movement facilitates continuous pressure redistribution, preventing prolonged compression on any single area of the body (Sundin and Wasserman, 2020).
How Lateral Rotation Mattresses Support Wound Healing
Wound healing in a pressure injury depends on three conditions at the wound bed: adequate capillary blood flow, controlled shear, and a stable skin microclimate. A lateral rotation mattress addresses each of these. The rotation relieves pressure from the dependent tissue and allows reactive hyperemia to restore oxygen and nutrient delivery to the skin. It reduces the mechanical shear that develops during manual repositioning. It also spreads moisture and heat across a larger skin surface, supporting a healing-friendly microclimate (EPUAP/NPIAP/PPPIA, 2019; Gefen et al., 2020).
In patients with stage 2 to stage 4 pressure injuries, clinical observation from the ABeWER multiTURN® 6 programme shows that a 30-minute rotation cycle limits the duration of vascular compression and supports tissue recovery (Chapeshis, 2025). Lateral rotation mattresses are most useful for wound healing when the patient cannot be manually turned at the recommended interval, when respiratory function benefits from postural change, or when existing wounds require continuous offloading rather than the cyclic micro-offloading provided by alternating pressure systems.
Clinical Benefits
Prevention of Pulmonary Complications
Lateral rotation assists in reducing pulmonary congestion, making it beneficial for patients prone to pneumonia, chronic obstructive pulmonary disease (COPD), and other respiratory complications (Thompson and Kelechi, 2019).
Pressure Redistribution
Effective in preventing and treating stage 1 to stage 4 pressure injuries by alleviating prolonged pressure on bony prominences and supporting wound healing through restored perfusion (EPUAP, 2019).
Reduced Need for Manual Repositioning
Beneficial for patients who require frequent turning but cannot be manually repositioned due to medical conditions, postoperative limitations, or caregiver constraints (Gefen et al., 2020).
Limitations
Not Suitable for All Patients
Patients with advanced hip pressure ulcers may experience increased discomfort or worsening conditions due to the lateral movement (Sprigle and Sonenblum, 2019). The ABeWER multiTURN® 6 addresses this limitation in advanced hip pressure ulcers by reducing discomfort and promoting wound healing through repositioning every 30 minutes. By minimising the duration of vascular compression, this mechanism ensures adequate perfusion of tissues with blood, oxygen, essential nutrients, and other healing factors, facilitating the recovery process (Chapeshis, 2025).
Risk of Patient Instability
Patients who require a highly inclined position (above 30 degrees) for medical reasons may face an increased fall risk (NPIAP, 2021).
Alternating Pressure Mattress (APM)
Mechanism of Action
An alternating pressure mattress consists of multiple air cells that inflate and deflate in a cyclic manner to continuously redistribute pressure and improve blood circulation (Schuler et al., 2018). This reduces ischemia and promotes tissue perfusion, which is essential for pressure injury prevention and wound healing.
Clinical Benefits
Enhanced Pressure Redistribution
APMs provide continuous reactive hyperemia, helping prevent skin breakdown and promote wound healing (Schank and Jacobsen, 2020).
Can Be Used in Various Positions
Unlike LRMs, alternating pressure systems can be used in both the flat and inclined position, making them suitable for patients who require head elevation (Gefen et al., 2020).
Suitable for All Stages of Pressure Injuries
Effective in treating stage 1 to stage 4 pressure injuries, including diabetic wounds and surgical wound management (Thompson and Kelechi, 2019). Optimal results depend on the frequency of repositioning, which is why combining an APM approach with a lateral-turning platform such as ABeWER multiTURN® 6 is increasingly recognised as the most effective configuration for pressure ulcer healing.
Limitations
Limited Respiratory Benefits
Unlike LRMs, alternating pressure systems do not assist in pulmonary secretion clearance (NPIAP, 2021).
May Require Additional Low Air Loss (LAL) Feature
For enhanced moisture control, some APMs integrate low air loss technology, which helps regulate skin microclimate (Sprigle and Sonenblum, 2019).
Lateral Rotation vs Alternating Pressure for Wound Healing
| Feature | Lateral Rotation Mattress (LRM) | Alternating Pressure Mattress (APM) |
| Primary Function | Rotates patient side to side | Alternates pressure under the body |
| Best For | Respiratory issues, wound healing with continuous offloading, pressure injury prevention | Pressure injury prevention and healing in variable positions |
| Wound Healing Mechanism | Postural change restores capillary flow and reduces shear across a large skin area | Cyclic air-cell inflation restores capillary flow at localised pressure points |
| Inclined Position | Primarily used in flat position | Can be used in inclined position |
| Pressure Redistribution | Rotation redistributes pressure | Cyclic pressure adjustment |
| Risk Considerations | May worsen hip pressure injuries; increased fall risk in inclined position | Requires additional LAL feature for moisture control |
Choosing the Right Mattress for the Patient
When to Choose a Lateral Rotation Mattress
- The patient has significant respiratory complications (e.g., pneumonia, COPD).
- The patient requires automated turning due to immobility.
- The patient has an existing stage 2 to stage 4 pressure injury that needs continuous offloading for wound healing.
- The patient does not have advanced hip pressure ulcers.
- The patient remains in a flat position most of the time.
When to Choose an Alternating Pressure Mattress
- The patient requires general pressure injury prevention and treatment.
- The patient is in various positions, including inclined.
- The patient does not have severe respiratory complications.
- The patient is independently mobile or transfers with assistance.
Frequently Asked Questions
Do lateral rotation mattresses help wound healing?
Yes. Lateral rotation mattresses help wound healing by continuously redistributing pressure, reducing shear, and restoring blood flow to the skin at the wound site. Clinical observation indicates a positive effect on stage 1 to stage 4 pressure injuries when the rotation cycle is frequent enough to prevent sustained tissue ischemia (NPIAP, 2021; Chapeshis, 2025).
What is the difference between a lateral rotation mattress and an alternating pressure mattress?
A lateral rotation mattress moves the patient side to side through a defined angle at set intervals. An alternating pressure mattress inflates and deflates air cells under the body in a cyclic pattern. Lateral rotation produces larger-scale postural change and supports pulmonary drainage. Alternating pressure supports continuous capillary reperfusion at localised contact points without moving the patient (EPUAP, 2019).
Are lateral rotation mattresses effective for stage 3 and stage 4 pressure injuries?
Yes, when the rotation interval is frequent enough to prevent prolonged loading of the wound bed. Evidence from the ABeWER multiTURN® 6 clinical programme reports healing or improvement in the majority of a stage 4 cohort when rotation is combined with appropriate stage-specific wound dressing selection (Chapeshis, 2025).
When should a lateral rotation mattress not be used?
Lateral rotation is not indicated for patients with advanced hip pressure ulcers where rotation may load the wound, for patients who require a highly inclined position above 30 degrees where fall risk increases, and for patients with spinal instability (NPIAP, 2021).
How often does a lateral rotation mattress turn the patient?
Rotation frequency varies by device. Older systems rotate every one to two hours. Newer multifunctional lateral turning mattresses (MLTM), including the ABeWER multiTURN® 6, rotate every 30 minutes, which aligns more closely with the clinical threshold for preventing sustained vascular compression (Chapeshis, 2025).
Is a lateral rotation mattress better than manual turning for wound healing?
A lateral rotation mattress supplements, rather than fully replaces, manual repositioning and skin assessment. For patients who cannot be turned at the recommended interval due to staffing limitations, spinal precaution, or postoperative restriction, a lateral rotation mattress provides continuous offloading that manual turning alone cannot achieve (Gefen et al., 2020).
Conclusion
Both lateral rotation mattresses (LRM) and alternating pressure mattresses (APM) serve critical roles in pressure injury prevention and treatment. Their effectiveness depends on the patient’s specific medical needs. LRMs are particularly beneficial for patients with respiratory concerns, limited mobility, and existing wounds that require continuous offloading, which is why lateral rotation mattresses for wound healing remain a primary choice in stage 2 to stage 4 pressure injury management. APMs are more versatile for variable positioning and general prevention. Proper assessment of the patient’s condition and clinical needs is essential for selecting the most appropriate therapy.
References
- Chapeshis, C. (2025). The impact of ABeWER multiTURN® 6 on advanced hip pressure ulcers: A novel approach to pressure injury management. Journal of Wound Care & Prevention, 32(1), pp. 45-60.
- European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP) and Pan Pacific Pressure Injury Alliance (PPPIA), 2019. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. 2nd ed. London: EPUAP.
- Gefen, A., 2008. The biomechanics of sitting-acquired pressure ulcers in patients with spinal cord injury: an interdisciplinary perspective. Ostomy/Wound Management, 54(10), pp.26-44.
- Gefen, A., Oomens, C. and Bader, D., 2020. Pressure ulcers: Pathophysiology, risk factors and prevention. Wound Repair and Regeneration, 28(5), pp.558-567.
- National Pressure Injury Advisory Panel (NPIAP), 2021. Clinical Guidelines for Pressure Injury Prevention. Washington, D.C.: NPIAP.
- Schank, J.E. and Jacobsen, E.J., 2020. The role of support surfaces in wound management. Journal of Wound Care, 29(1), pp.21-29.
- Schuler, M. et al., 2018. Alternating pressure mattresses and their effect on blood circulation. Advances in Skin & Wound Care, 31(9), pp.410-417.
- Sprigle, S. and Sonenblum, S.E., 2019. Assessing tissue health in pressure ulcer prevention. Advances in Wound Care, 8(2), pp.57-64.
- Sundin, C. and Wasserman, L., 2020. Comparative effectiveness of support surfaces for pressure injury prevention. Critical Care Nursing Quarterly, 43(3), pp.267-275.
- Thompson, P. and Kelechi, T., 2019. Clinical approaches to pressure injury prevention in at-risk populations. Journal of Clinical Nursing, 28(7-8), pp.1245-1255.