Procedure
The goals of surgical reconstruction are: clean wounds, removal of infected tissue, hemostasis, closure of the defect with viable tissue, tension-free closure, and relief of pressure on the reconstructed tissue.
Depending on the affected area, the defect can be covered in different ways:
Skin Graft
- What is that? Superficial wounds can be covered with a skin graft (split-thickness or full-thickness). In this procedure, a piece of skin corresponding to the size of the defect—for example, from the thigh—is removed and transplanted onto the clean wound. The puncture site usually heals without any problems under a wound dressing.
- What is important after surgery? After the surgery, the transplanted area must be kept still for 5 days. After 5 days, the first dressing change is performed, along with an assessment of how the split skin has healed.
- What are the surgery-specific complications? The first 5 days are critical for the skin graft to take. There is a possibility that the skin will not heal, and the defect will need to be covered again. This is a rare complication.
Flap Reconstructions
- Local flap surgery
- What is that? In the area of the buttocks and coccyx, defects can be covered, for example, by repositioning tissue (skin, subcutaneous fat, muscle fascia). In this procedure, tissue that is anatomically adjacent—for example, from the buttocks, thigh, or back—can be advanced into the defect or rotated into it.
- What is important after surgery? Consistent reduction of pressure on the surgical site.
- What are the surgery-specific complications? Wound-healing disorders and recurrent pressure ulcers are among the possible complications.
- Distant/Free-Standing Sculptures:
- What is that? If tissue cannot be harvested from the anatomical area adjacent to the pressure ulcer (local flap surgery), tissue must be taken from a part of the body that is farther away from the pressure ulcer. In this procedure, for example, skin-fascia flaps, muscle flaps, or skin-muscle flaps are harvested from the trunk or the extremities. The vessels (veins and arteries) are connected to the recipient vessels near the defect using microsurgery.
- What is important after surgery? Regular monitoring of blood flow to the flap after surgery. Using a handheld ultrasound, the doctor will check the flap every hour or every few hours for 5 days after the surgery. In addition, pressure is relieved from the surgical site.
- What are the surgery-specific complications? Wound-healing disorders, poor blood flow, or a lack of blood flow to the flap may necessitate a repeat coverage procedure. These are rare complications.
In the case of flap procedures, care must be taken to relieve pressure on the pressure ulcer site for 3–6 weeks after surgery. This means that you are not allowed to sit or lie down on the reconstructed area. Body positions that relieve pressure on the area (e.g., lying on one’s side or on one’s stomach) must be maintained consistently so that the displaced tissue integrates well into the defect.
Every patient—and every wound—is unique. That is why we place a high value on personalized care. If you are planning surgical treatment for a pressure ulcer, we would be happy to advise you during our consultation hours at the Department of Plastic and Hand Surgery.