What is the process of surgical débridement for the treatment of 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

Once the decision has been made to reconstruct, the wound is debrided. It should be noted that débridement of a pressure injury that will be reconstructed is different from débridement of a pressure injury that will be treated conservatively (ie, allowed to heal by secondary intention).

Pressure injuries that are treated conservatively are not radically debrided; they need only be debrided of obvious necrotic tissue. For pressure injuries that will be reconstructed, a radical bursectomy is performed to prevent the development of infection or seroma under the flap. This radical bursectomy is technically achieved by placing a methylene blue–moistened sponge in the bursa and excising the pressure injury circumferentially, removing all granulation tissue, even from the wound base (see the image below).

Radical bursectomy is performed by placing methyle Radical bursectomy is performed by placing methylene blue–moistened sponge in bursa and excising pressure ulcer circumferentially, removing all granulation tissue, even from wound base.

After the bursectomy, primary closure of the pressure injury is almost always under tension and is therefore doomed to fail if attempted. Other technical points of pressure injury reconstruction include radically removing underlying necrotic bone, padding of the bone stump, filling the dead space with muscle, using a large flap, achieving adequate flap mobilization to avoid tension, and avoiding adjacent flap territories to preserve options to reconstruct other locations.


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