Prehabilitation for Pressure Ulcer Surgery: A Practical and Evidence-based Guide

The objective of this study is to synthesize current evidence and provide a clinically actionable framework for perioperative prehabilitation in patients undergoing pressure ulcer (PU) reconstruction.

We conducted a narrative synthesis of the best available evidence, including clinical guidelines, randomized controlled trials, observational studies, and expert consensus statements relevant to perioperative optimization for PU surgery. Literature was reviewed across key domains known to influence surgical outcomes. Evidence was translated into patient-centered, clinically actionable recommendations.

Preoperative optimization across nutritional, mechanical, and functional domains was associated with improved wound healing and reduced postoperative complications in PU reconstruction. Nutritional supplementation with an 8-week course of vitamins A, B₉, C, and E, along with zinc, selenium, and copper, was associated with improved outcomes. Comprehensive nutritional assessment was essential; although albumin and prealbumin may suggest malnutrition, tools such as the NUTRIC (Nutrition Risk in the Critically Ill) score, dietary intake evaluation, and body composition analysis provided more accurate risk stratification. Pressure off-loading surfaces reduced shear forces and improved tissue perfusion. Smoking cessation for a minimum of 30 days improved vascular and immune recovery. Tailored preoperative exercise programs, delivered through physical therapy, enhanced functional reserve. Among ambulatory patients, metabolic equivalent levels less than 4 identified higher perioperative risk, with prehabilitation notably improving functional capacity.

Multidisciplinary, evidence-based prehabilitation targeting modifiable risk factors improves physiological readiness and surgical outcomes in PU reconstruction. Standardized implementation of nutritional optimization, off-loading strategies, smoking cessation, and functional conditioning may reduce complications and recurrence while enhancing postoperative recovery.