What are pressure sores?

Pressure sores or decubitus ulcers or pressure ulcers are that wounds formed due to a constant pressure on specific parts of the body. The common sites affected are lower end of spine, outer side of thigh, heel, elbow, and back of head. Approximately 70%-90% of pressure ulcers diagnosed are superficial and classified as stage I and stage II.

The treatment strategies preferred for them are non-surgical interventions such as reducing pressure, adequate debridement, and meticulous care. Stage III and IV pressure sores require surgical interventions as they do not heal even after thorough and comprehensive medical management.

What is pressure sore reconstructive surgery?

Reconstructive surgery for pressure sore aims to heal the ulcers and minimize the risks associated with the open wounds. The surgery involves removal of the affected bone and tissue, and covering the post excision wound or defect with a healthy tissue.

Your surgeon will choose the treatment strategy by considering the stage of a pressure sore (stage III and stage IV)

What are the types of the surgeries?

You surgeon may choose one of the different options available for the surgical management of the pressure ulcers based on the type, stage, and location of the lesion. The choice of reconstruction approach majorly depends on the locations which include ischial, sacral, or trochanteric.

The types include:

• Skin grafts
• Skin flaps
• Myocutaneous flaps
• Free flaps

Which individuals are eligible for the surgery?

Your doctor may recommend a surgery if

• you are diagnosed with stage 3 or stage 4 pressure sores

Stage 1 and stage 2 pressure ulcer are not healed with non-surgical measures .

You are considered as an ideal candidate for pressure sore reconstructive surgery if,

• the bacterial load has been sufficiently minimized
• nutritional status has been optimized
• you had a urethral fistula, and it is diverted and healed before reconstruction
• you have undergone diverting colostomy before reconstruction
• you are not diagnosed with any signs of spasticity

How should I prepare for the surgery?

Before attempting for surgical reconstruction of the pressure ulcers, your surgeon will give you few instructions to optimize your medical status. Optimizing the health status improves and accelerates the healing process. These instructions include:

• Taking the medications as prescribed ( this help to control spasticity)
• Following the recommended diet (Malnutrition may lead to improper healing)
• Postural turning
• Quitting or avoiding smoking
• Taking iron supplements (To correct anemia)
• Regular cleaning of the wound and surrounding intact skin

What will happen during the surgery?

You surgeon may follow the following steps while performing reconstruction of the pressure ulcers. The surgical debridement is performed without anesthesia. The steps include:

Step 1- Surgical debridement

Your surgeon performs radical bursectomy for wound debridement which helps to prevent the development of infection or seroma under the flap. This radical bursectomy is performed by placing a methylene blue moistened sponge in the bursa and excising the pressure sore peripherally, removing all granulation tissue from the wound base.

Step 2- Closing the wounds

There are several techniques available for closing the wounds after surgical debridement. These techniques include direct closure, skin grafting, skin flaps, and musculocutaneous flaps. Using these techniques for surgical management can provide skin coverage along with the soft tissue coverage. Flaps containing muscle which are also known as musculocutaneous flaps prevent infections by acting as a physiologic barrier, eliminate dead space in the wound and improve vascularity. Local oxygen tension can be enhanced with the improved vascularity this may also facilitate extended soft tissue penetration for antibiotics, improving

What is the aftercare of the surgery?

Recovery after pressure sore reconstructive surgery may take several weeks.

• Water or air mattress has to be used throughout the recovery period
• Postural turning has to done to prevent recurrence of pressure ulcer
• Perineal hygiene has to be maintained
• Regular inspection of pressure areas has to be made to detect any recurrence
• You are transferred to the air-fluid bed from the operating table and positioned flat for four weeks.
• In the 5th week, you are allowed to change your position to the semi-sitting position.
• In the 6th week, you are allowed to sit for only 10 minutes at a time.
• While sitting the wound should be examined for the discoloration and wound edge separation.
• You are taught to lift yourself to relieve pressure for 10 seconds every 10 minutes.
• Skin care should be performed daily to maintain optimum moisture to minimize the skin breakdown.

What are the postsurgical considerations?

Apart from recurrence other complications associated with this surgery includes:

• Hematoma
• Seroma
• Wound dehiscence
• Wound infection