Surgical reconstruction tips and pearls of pressure injury

What is it about?

Background: Pressure injuries are localised tissue defects that occur due to increased pressure on the skin that causes ischemic damage.These injuries are more frequently seen in patients who are immobile, elderly, malnourished, or have a history of intensive care unit stays. The management of pressure injuries consists of conservative treatment, including wound care and ultimately, surgical closure of the wound. Aim: The aim of this study is to compare the long-term clinical outcomes of patients who underwent surgery for pressure injuries in our chronic wound clinic and to develop an algorithm for flap selection, highlighting the most appropriate options for approaching pressure injuries. Methods: Our study includes 97 patients are people with grade 3 and 4 pressure injuries, who were followed up between January 2017 and December 2024. The patients were classified and followed up based on factors such as the location of tissue defects, length of hospital stay, type of surgery performed, presence of bacterial growth in cultures, use of NPWT, comorbidities, wound size, and the success of the surgical treatment. Results: Cases reconstructed with flaps had 30.6% detachtment rates and were observed at the same time as cases with skin grafts who showed an 86.5% viability rate. Average hospital stay for patients with skin graft was avarage of 11.3 days, and for patients reconstructed with flaps 37.1 days. Conclusion: Pressure injuries require different approaches from other chronic wounds. Treatment should be tailored according to patient and surgeons should take every possible outcome into consideration. Implication for clinical practice: Reconstruction with flaps, even with high complication rates, should be first line of choice and skin grafting should be limited with patients who are immobile and have superficial skin defects.

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