Surgical Options for Advanced Pressure Injuries
The August 2025 issue of Advances in Skin & Wound Care features an in-depth review on surgical approaches to managing advanced pressure injuries. The article examines current indications, patient selection, and procedural strategies for debridement, tissue reconstruction, and long-term wound closure in patients with stage 3 or stage 4 pressure injuries.
Key Points Covered:
- Indications for Surgery: Persistent non-healing wounds despite optimal conservative care, exposure of bone or tendon, and recurrent infections.
- Surgical Techniques: Sharp debridement, negative pressure wound therapy with instillation, and flap-based reconstructions such as myocutaneous and fasciocutaneous flaps.
- Pre-Op Considerations: Nutritional status, infection control, patient mobility, and psychosocial support all impact surgical eligibility and outcomes.
- Outcomes and Challenges: Surgical success rates are improved with multidisciplinary care and patient adherence to post-op offloading and follow-up protocols. However, recurrence remains a risk in high-pressure zones like the sacrum and ischial areas.
Clinical Relevance: Surgical intervention is not appropriate for all patients with pressure injuries, but for carefully selected individuals, it can offer faster healing and reduced infection risk. The article advocates for collaborative care planning between surgeons, wound care nurses, physical therapists, and nutritionists.
Keywords: pressure injuries, surgical debridement, flap reconstruction, wound surgery, negative pressure wound therapy, multidisciplinary wound care