Pressure ulcer reconstruction is surgery to close a deep pressure sore caused by prolonged pressure on skin and tissue over a bony prominence, as can happen in people with paralysis or who are confined to bed. Its aim is to close the wound, protect the bone and lower the risk of infection, and the treating team decides whether it suits the patient after assessing overall health.
Beforehand, pressure is relieved, nutrition improved and infection and other illnesses controlled. Under general or spinal anaesthesia the surgeon removes dead and infected tissue and any inflamed bone, then covers the ulcer with a flap of nearby muscle or skin and fat moved with its blood supply, and places drains.
Surgery usually takes two to four hours. It requires a hospital stay of several days to weeks on a pressure-relieving bed, avoiding pressure on the repair for a period set by the team. Lifelong pressure relief is essential. The wound usually heals over several weeks, and the repair is monitored for months to confirm it is stable.
The final cost is set after a medical consultant reviews your case and photos.
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It may close a long-standing wound, reduce infection and pain, protect the bone from damage, make care easier and improve quality of life. The outcome depends on general health and on keeping pressure off the area.
Usually a patient whose nutrition has improved, whose infection and other illnesses are controlled, and who or whose carers can follow pressure-relief instructions. It may not suit some advanced or unstable cases, and the treating team decides after assessment.
Preparation includes relieving pressure on the area, cleaning the wound, treating infection with antibiotics if needed, improving nutrition, controlling diabetes and stopping smoking. Patients never stop a prescribed medicine on their own; the doctor decides.
Under general or spinal anaesthesia, dead tissue and infected bone are removed, and the ulcer is covered with a flap of nearby muscle or skin and fat. Drains are placed and the wound is closed. The surgeon chooses the flap according to the site and size of the ulcer.
It involves a relatively long stay on a special bed, regular position changes and keeping pressure off the area for a period set by the team, followed by gradual return to sitting under their supervision. The flap and wound are monitored, with attention to nutrition, hygiene and skin care.
The wound usually heals within weeks, but confirming a stable repair takes months. Ulcers can recur, and the risk is higher without consistent pressure relief, skin care and nutrition. Some patients need further surgery.
Risks include infection, which can be serious, blood or fluid collections, wound breakdown, partial or complete flap failure, recurrence of the ulcer, bleeding, blood clots and anaesthetic risks. Complications may need further operations, and risks are higher with poor nutrition, infection or other illness. The team explains them frankly.
Yes. A scar remains over the ulcer site and the flap area. What matters most is healthy skin rather than appearance, and the repaired tissue may have reduced sensation.
Waiting until the wound has fully healed and the team allows long periods of sitting is advised, since sitting during a journey can put pressure on the repair. Do not travel before the treating team confirms the timing.
Recurrence cannot be ruled out, but the risk is lowered by relieving pressure with regular position changes, using special cushions and mattresses, checking the skin daily, keeping it clean and dry, eating adequately and controlling conditions such as diabetes. The team draws up a follow-up plan for you and your carers.
