How is reconstruction performed for pressure injuries (pressure ulcers)?

Updated: Mar 26, 2020
  • Author: Christian N Kirman, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

The first step is adequate excision of the injury, including the bursa or lining, surrounding scar tissue, and any heterotopic calcification found. Underlying bone must be adequately debrided to ensure that there is no retained nidus of osteomyelitis. Some evidence in the literature indicates that pulsed lavage can be beneficial in reducing bacterial counts in wounds, and some surgeons routinely use this method after débridement.

Once the wound has been appropriately debrided, it may be closed in a variety of ways, depending on the location of the pressure injury, any previous scars or operations, and the surgeon’s individual preference. However, the basic tenets of reconstruction remain the same in all pressure injury reconstructions.

Very few pressure injuries can or should be closed primarily after débridement, given the unacceptably high complication rates. A well-vascularized pad of tissue should be placed in the wound, usually a musculocutaneous flap transposed or rotated on a pedicle containing its own blood supply. This also may involve the use of tissue expansion or a free flap with microvascular anastomosis. The goals are to eliminate dead space in the wound, enhance perfusion, decrease tension on the closure, and provide a new source of padding over the bony prominence.

Before wound closure, drains should be placed in the bed of the wound. This allows external drainage of any fluid that may accumulate beneath the flap and should help minimize wound complications such as hematoma and seroma.


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