Treating Pressure Injuries: Surgery

A large pressure injury is a threat to a patient's health. Without surgical repair, these wounds can take a long time to heal. This can raise the risk for serious complications such as osteomyelitis, sepsis, and, in rare situations, cancerous changes. If surgical repair of an injury is needed, review the goals of care with the patient.

Surgical flap and skin graft

Surgery is generally required in severe and deep pressure injuries. The goal is to close the injury and provide padding over the bony prominence. For good surgical outcome, extensive cleaning and debridement is done at the site of the pressure injury. Vacuum-assisted closure (VAC) may be employed before the surgery to obtain a favorable wound for the surgical closer. Healthy tissue from another part of the body is often used. A muscle flap is one way of repairing the injury. Since a flap retains its own blood supply, it allows for more rapid healing. It fills the dead space and provides durable skin over the operated site. A skin graft can also close the wound. Living or artificial skin may be used.

After surgery

The patient should take these precautions after a surgical procedure:

• Keep pressure off the affected area.

• Keep the sutures clean.

• Ensure wound drains stay open.

• Watch for signs of infection (such as fever or pus discharge) and hematomas.

• Watch for signs of impaired healing, such as a change in wound color, swelling, or abnormal drainage.

• Maintain adequate nutrition

Adherence to these precautions has been shown to be the best predictor of wound healing.