Comprehensive Review of Pressure Sores: Pathophysiology, Prevention, and Surgical Management

Pressure sores, or decubitus ulcers, are a common and debilitating complication of immobility, particularly affecting individuals with spinal cord injuries, advanced age, or prolonged hospitalization. These wounds result from sustained pressure exceeding capillary perfusion pressure, leading to tissue ischemia and necrosis, often beginning at the muscle-bone interface. Despite preventive efforts, pressure sores remain highly prevalent and frequently recur, posing significant challenges to patient care and health care systems. This review outlines the underlying pathophysiology and risk factors for ulcer development, with a focus on high-risk populations. Prevention strategies, including specialized support surfaces, frequent repositioning, and nutritional optimization, are essential for reducing incidence and severity. Established ulcers can require surgical debridement for wound control and complex reconstructive procedures for closure. Perioperative planning, including strict offloading protocols and infection control, is key to long-term flap durability. Emerging regenerative approaches, such as stem cell-enriched matrices and growth factor therapies, show promise as adjuncts or alternatives to traditional reconstruction. By integrating prevention, precise surgical technique, and biological innovation, robust outcomes in pressure sore management are increasingly within reach. Ongoing research should prioritize long-term outcomes and the reduction of recurrence in high-risk populations.