Surgical treatment of pressure ulcers.

Although a pressure ulcer is a potentially serious condition that always calls for treatment, only a small percentage of patients with pressure ulcers are candidates for surgery. The choice between conservative treatment and surgery for a pressure ulcer depends on a thorough evaluation of the ulcer, as well as the patient's physical and mental states. In general, superficial pressure ulcers (stages I and II) are likely to benefit from conservative treatment. Deep pressure ulcers (stages III and IV, often resulting from spinal cord injury) often require surgical intervention. The surgical techniques described in this essay include direct closure (which is rarely indicated), local and sensate flaps, and skin grafting. Skin transplantation and cutaneous and other thin flaps have more limited indications in pressure ulcer surgery. Thorough debridement before reconstruction, patient compliance, control of concomitant disease, professional postoperative support, and sufficient pressure relief are imperative for treatment success.