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Outcomes and Challenges of Flap Reconstruction for Pressure Injuries in Clinically Complex Patients
Stephanie M Mueller1,2, Ovya Ganesan3, Ana M Pachano-Bravo2
1Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
Journal of Clinical Medicine
|June 26, 2026
Summary
Flap reconstruction for pressure injuries (PIs) in complex patients has high complication and recurrence rates. Careful patient selection and optimized postoperative care are crucial for better outcomes.
Area of Science:
- Plastic Surgery
- Wound Care
- Reconstructive Surgery
Background:
- Pressure injuries (PIs) are prevalent in immobile patients, often necessitating flap reconstruction.
- Postoperative complications and recurrence are significant challenges following PI flap reconstruction.
- Outcomes vary by flap type, highlighting the need for specific evaluations.
Purpose of the Study:
- To evaluate the outcomes of flap reconstruction for pressure injuries (PIs) in a medically complex patient cohort.
- To identify factors influencing success and complications in PI flap reconstructions.
Main Methods:
- Retrospective review of patients undergoing flap reconstruction for sacral, ischial, trochanteric, or lateral malleolar PIs.
- Data collection included demographics, comorbidities, wound characteristics, flap type, and postoperative outcomes.
- Outcomes were analyzed at the flap level over an eight-year period.
Main Results:
- 101 flap reconstructions were performed in 68 patients, predominantly males with spinal cord injuries.
- High comorbidity burden observed: anemia (61%), malnutrition (42%), osteomyelitis (44%), stool exposure (49%), and incontinence.
- Common complications included wound dehiscence and PI recurrence (21% at operative site); 14% developed new PIs.
- Mortality rate was 28% over the follow-up period.
Conclusions:
- Flap reconstruction is vital for advanced PIs but carries high complication and recurrence risks in comorbid, immobile patients.
- Findings underscore the importance of meticulous patient selection and preoperative optimization.
- Multidisciplinary postoperative care is essential to prevent new PIs and manage existing ones.
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