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Surgical and reconstructive management of pressure ulcers

  • Master Class in Plastic Surgery
  • Published:
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Abstract

Despite significant advances in therapeutic options, pressure ulcers continue to pose a challenge to physicians and surgeons and frequently require multidisciplinary input. In addition, they place huge financial burdens on health care providers. Generally classified as grades I to IV depending on the extent and severity of the ulcer, grades I and II are usually amenable to conservative management. Grades III and IV may require surgical intervention, which could either be simple debridement or complex reconstructive microsurgery. Direct closure or skin grafting is useful in only a small number of early pressure ulcers. For non-healing and advanced pressure ulcers, reconstructive surgery is indicated, which consists of soft tissue flap coverage such as fasciocutaneous, musculocutaneous, perforator, or free flaps. The selection of a particular flap depends on a variety of factors, for instance, the location and grade of the ulcer, vascularity of the surrounding tissue, mobility of the patient, and the experience and expertise of the surgeon. There are no clear guidelines at present regarding the suitability of a particular flap in the management of pressure ulcers at different stages. This article aims to provide an overview of the etiology, pathophysiology, and management of pressure ulcers in various anatomical locations, with particular emphasis on current advances in reconstructive surgical procedures.

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Authors and Affiliations

  1. Surgery, All-Wales Higher Surgical Training Program, Glan Clwyd Hospital, Rhyl, LL18 5UJ, UK

    Valentina Lefemine

  2. Burns and Plastic Surgery, North-West Regional Center for Burns and Plastic Surgery, University Hospital of South Manchester, Manchester, UK

    Stuart Enoch

  3. Plastic and Hand Surgeon, Welsh Center for Plastic Surgery and Burns, Morriston Hospital, Swansea, UK

    Dean Edward Boyce

Authors
  1. Valentina Lefemine
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  2. Stuart Enoch
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  3. Dean Edward Boyce
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Correspondence to Valentina Lefemine.

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Lefemine, V., Enoch, S. & Boyce, D.E. Surgical and reconstructive management of pressure ulcers. Eur J Plast Surg 32, 63–75 (2009). https://doi.org/10.1007/s00238-008-0318-z

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  • DOI: https://doi.org/10.1007/s00238-008-0318-z

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