Pressure ulcers – surgical treatment

Surgery becomes necessary when a pressure ulcer reaches grade III and grade IV. These can no longer be treated with wound dressings and the tissue defect remains without surgical treatment (reconstruction) in the long term. This can lead to serious infections.


The aims of surgical reconstruction are: clean wounds, removal of infected tissue, hemostasis, closure of the defect with vital tissue, tension-free closure and relief of the reconstructed tissue.

Depending on the affected area, the defect can be covered in different ways:

Skin grafting

  • What is that? Superficial wounds can be covered by skin grafting (split skin or full-thickness skin). A piece of skin corresponding to the size of the defect is removed from the thigh, for example, and transplanted onto the clean wound. The donor site usually heals without any problems under a wound dressing.
  • What is important after the operation? After the operation, the transplanted area is immobilized for 5 days. After 5 days, the first dressing change takes place with assessment of the growth of the split skin.
  • What are the surgery-specific complications? The first 5 days are critical for the skin graft to grow. There is a possibility that the skin will not grow back and the defect will need to be covered again. This is a rare complication.

Flap plastics

  • Local flap surgery
    • What is that? In the area of the buttocks and coccyx, defects can be covered, for example, by moving tissue (skin, subcutaneous fat, muscle fascia). Tissue that is anatomically located in the vicinity, for example from the buttocks, thigh or back, can be advanced into the defect or rotated into the defect.
    • What is important after the operation? Consistent relief of the surgical site.
    • What are the surgery-specific complications? Wound healing disorders and recurrence of pressure sores are among the possible complications.
  • Remote/free flap plastics:
    • What is that? If tissue advancement from the anatomical vicinity of the pressure ulcer is not possible (local flap plasty), tissue from the body further away from the pressure ulcer is required. For example, skin fascia flaps, muscle flaps or skin muscle flaps are lifted from the trunk or extremities. The vessels (veins and arteries) are connected to the recipient vessels near the defect using microsurgery.
    • What is important after the operation? Regular monitoring of flap blood flow after the operation. The doctor will use hand ultrasound to check the flap every hour or several hours for 5 days after the operation. In addition, the surgical area is relieved.
    • What are the surgery-specific complications? Wound healing disorders, poor blood supply or lack of blood supply to the flap may make re-covering necessary. These are rare complications.

In the case of flap plasty, care must be taken postoperatively to relieve pressure in the area of the pressure ulcer for 3-6 weeks. This means that you are not allowed to sit or lie on the reconstructed area. Body positions that lead to relief of the area (e.g. lateral or prone position) must be consistently maintained so that the displaced tissue integrates well into the defect.

Every patient and every wound is individual. We therefore attach great importance to individual treatment. For the planning of surgical coverage and the procedure for your pressure ulcer, we will be happy to advise you in our consultation hours at the Clinic for Plastic and Hand Surgery.

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