Predictors of Pressure Ulcer Recurrence and Complications after Flap Reconstruction

Pressure ulcers impose a significant healthcare burden on both the individual and societal level. The gold standard for treatment is flap reconstruction, which historically has high complication and recurrence rates. The aim of our study was to determine factors associated with complications and recurrence in our large patient population.

Retrospective chart review of patients who underwent muscle, myocutaneous, or fasciocutaneous flaps from January 2010 to July 2022 for pressure ulcer reconstruction at our tertiary academic institution. Demographic and outcome data were analyzed to determine factors associated with complications and recurrence.

A total of 326 patients met inclusion criteria, with 418 flaps performed. Recurrence occurred in 98 flaps (23.4%), and the complication rate was 48.3%. Factors significantly associated with recurrence (p < 0.05) included elevated preoperative CRP, current tobacco use, post-operative infection, and non-compliance. Factors associated with lower recurrence included higher preoperative prealbumin (p = 0.01), preoperative IV antibiotics (p < 0.0001), and autonomic dysfunction (p = 0.04). Preoperative osteomyelitis, present in 70.2% of cases, was not linked to recurrence but was associated with higher complication rates (p = 0.01). A pre-operative optimization algorithm was created. Patients who followed it had lower recurrence (17.3%) and complication rates (46.4%) compared to those who did not (24.6% and 48.7%, respectively).

Modifiable pre- and post-operative factors influence pressure ulcer recurrence following flap reconstruction. Optimizing nutrition, infection control, smoking cessation, and patient compliance may improve outcomes.