Surgery to Treat Pressure Ulcers
When a pressure ulcer is closed properly, you can sit and lie down more comfortably, feel less pain, and return to daily life without worrying about a wound that leaks every day.
Is this right for you?
A pressure ulcer is damage to the skin and the tissue beneath it that forms when one area of the body bears pressure for a long time. It tends to happen in people who move little or stay in bed for long periods. When an ulcer is deep and reaches the fat, muscle, or bone, wound care alone often cannot close it, and surgery can be one option. Whether surgery suits you depends a great deal on your overall health, your nutrition, and your ability to keep pressure off the area after the operation.
This may be a good fit if
- You have a deep ulcer (usually stage III or IV) that has not healed after a long stretch of proper wound care and dressing changes.
- Your overall health is stable enough to come through surgery and the recovery that follows.
- You (or your caregiver) can keep pressure off the surgical area afterward, for example by turning your position regularly and using a pressure-relieving mattress.
- Underlying factors such as infection, poor nutrition, or blood sugar are under control or improving.
This may not be right if
- You have a severe infection that is not yet controlled, or your general condition is not stable enough for anesthesia and surgery.
- Pressure on the ulcer cannot be relieved after surgery, because the wound would then be very likely to return.
- Your nutrition, blood sugar control, or other underlying conditions have not been addressed, which lowers the chance of healing.
- You smoke and are not yet able to stop, because smoking reduces blood flow to the tissue and gets in the way of the wound healing.
How it works
The first visit is an examination and a conversation. Your doctor will assess how deep and how large the ulcer is, check whether there is infection or dead tissue, and ask about your nutrition, your underlying conditions, and the care you have at home. Sometimes blood tests or imaging are needed to find out whether the damage has reached the bone. Surgery is usually considered only after the ulcer is clean and your overall health has been improved as much as possible.
The type of anesthesia depends on the location and depth of the ulcer and on your health; it may be general anesthesia or a regional block. Your doctor will explain which option suits you and why.
During the operation, your doctor first performs debridement, which means removing dead and infected tissue until only healthy tissue remains. If the damage has eaten into the bone, the diseased part of the bone may be removed or smoothed. Then, to close the gap, your doctor often uses a tissue flap, which is a section of skin, fat, and sometimes muscle taken from a nearby area and moved to cover the ulcer. The specific technique is chosen based on where the damage is and how deep it goes.
Once the wound is closed, the area is dressed, and a small drain is usually placed to let fluid escape over the next few days. The recovery plan, especially how to keep pressure off the surgical area, is set from the very start, because this is the key factor in whether the wound heals and stays healed.
Realistic expectations
The aim of surgery is to close the ulcer with healthy tissue, reduce pain and the risk of infection, and lay the groundwork for you to live more comfortably. This is a procedure about function and health, not about appearance, so your hopes should rest on healing and on preventing the ulcer from coming back.
What this will not do
- Surgery cannot, on its own, stop the ulcer from returning if pressure on the area is not relieved regularly afterward.
- Your doctor will not promise a specific outcome, because healing depends on your nutrition, your underlying conditions, and how the area is cared for.
- Surgery does not restore feeling or movement that was lost from whatever first caused the long period in bed.
- The area covered by the tissue flap will not be as tough or able to bear weight as intact skin, so it will still need long-term protection.
Recovery
Recovery after pressure ulcer surgery usually takes time and asks for patience. Most of that time goes toward keeping the surgical area completely free of pressure, so the newly closed tissue has the chance to heal. The milestones below are rough general estimates; your actual timeline is set by your doctor based on your particular situation.
- The first few days
- You stay in the hospital so the wound can be watched, pain can be managed, and the drain can be cared for. The surgical area is kept off pressure from the very first hour.
- About 1 to 3 weeks
- You continue to hold positions that avoid pressure, usually lying on a specialized mattress. The drain is removed once the fluid drops enough.
- About 3 to 6 weeks
- Your doctor assesses how well the tissue flap has healed. Sitting or bearing weight again is allowed gradually and very slowly, following guidance.
- The following months
- The tissue keeps growing stronger. You maintain a routine of turning, use a pressure-relieving mattress, and return for follow-up visits to watch for any return of the ulcer over the long term.
Risks & safety
Every surgery carries risk, and pressure ulcer surgery has its own concerns because of the nature of the wound and the underlying health of the person. Your doctor will talk openly about these possibilities before you decide.
- The ulcer returning, especially if pressure on the surgical area is not relieved enough after surgery.
- The wound opening partly or fully, when the wound edges or the tissue flap do not heal as hoped.
- The tissue flap losing its blood supply and partly dying, which may need further treatment.
- Infection at the wound or spreading deeper, sometimes needing antibiotics or another operation.
- A collection of blood or fluid under the tissue flap, which may need draining.
- Bleeding during or after surgery, and the risks that come with anesthesia.
- Slow healing in people with poor nutrition, diabetes, or other underlying conditions.
How we do it
At The Gioi Dep, our doctors approach a pressure ulcer as a problem of the whole body, not just the wound. Before any talk of surgery, the team assesses your nutrition, the control of your underlying conditions, any infection, and the care you have available, because these factors decide whether the wound will heal. The plan is built for each individual and explained clearly, so you understand why each step matters.
Care does not end when you leave the operating room. Our doctors give you specific guidance on how to relieve pressure on the surgical area, how to turn your position, and when to return for follow-up so healing and any risk of return can be watched. When needed, you are connected with wound care nurses and related specialists to support your recovery over the long term.
Frequently asked questions
Is the surgery painful?
During the operation you are under anesthesia, so you feel no pain. Afterward there is pain and a tight, full feeling in the surgical area, which is managed with pain medicine as your doctor directs. How much pain you feel varies from person to person.
How long will I stay in the hospital?
Your hospital stay depends on the location and depth of the ulcer and on how quickly you recover, and it is often longer than for many other operations because the surgical area must be kept off pressure. Your doctor will estimate this for your case.
Why do I have to avoid pressure on the area for so long?
Long-lasting pressure is exactly what caused the ulcer in the first place. If the surgical area bears pressure too soon, the newly closed tissue has no time to heal and the wound is very likely to open or return. Keeping that area free of weight is the most important part of recovery.
Can the ulcer come back after surgery?
It can come back, especially when pressure on the area is not relieved steadily over time. This is why turning your position, using a pressure-relieving mattress, and keeping up long-term follow-up matter so much for holding the result.
What kind of scar will I have?
Closing the wound surgically leaves a scar at the surgical area and at the area where tissue was taken. Because this is a procedure about function and health, the main goal is to close the ulcer and prevent infection rather than the look of the scar.
I am older. Can I still have surgery?
Age is not the only deciding factor. What matters more is your overall health, your nutrition, and the care you can get afterward. Your doctor will look at the whole picture so you can weigh together whether surgery suits you.
What if I do not have surgery?
For a shallow ulcer, wound care, relieving pressure, and improving nutrition may be enough for it to heal. For a deep ulcer, without treatment the wound can linger, become infected, or spread. Your doctor will talk through the options that suit you.
What do I need to do to prepare for surgery?
Usually you need to improve your nutrition, control your blood sugar and other underlying conditions, get the ulcer clean, and stop smoking if you smoke. The goal is to bring your body into the best possible state for the wound to heal.
Will I need a caregiver after surgery?
Most cases need help with turning your position, changing dressings, and keeping the surgical area off pressure for many weeks. Your doctor and nurses will show you and your caregiver how to do this.
The next step
The next step is a conversation - book a consultation.
The content on this page is for reference only and does not replace a direct examination and consultation with a specialist physician. Surgical outcomes vary from person to person.