Pressure sore reconstruction (Flap reconstruction of a pressure ulcer (decubitus ulcer))

What is pressure sore reconstruction?

A pressure ulcer (also called a pressure sore, bedsore or decubitus ulcer) is a wound that forms when an area of skin and the tissue beneath it is squeezed for too long, cutting off its blood supply. They develop over bony areas — most often the lower back (sacrum), the sitting bones (ischium) or the hip — in people who cannot move freely, such as those with a spinal cord injury, reduced mobility or serious illness.

Many pressure ulcers are managed without surgery, through pressure relief, wound care and good nutrition. Reconstruction is considered for deep or non-healing ulcers, where surgery can clean out the unhealthy and infected tissue (debridement) and then close the wound by moving healthy nearby tissue — skin, fat and sometimes muscle — over it as a 'flap'.

The single most important thing to understand is that surgery treats the wound, not its cause. Unless the pressure, and the factors that led to the ulcer, are tackled — repositioning, the right cushion or mattress, nutrition, managing moisture and stopping smoking — the ulcer is very likely to come back. Recurrence after pressure-sore surgery is common, so reconstruction is one part of a much wider plan, not a stand-alone fix.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• Expect the team to optimise your health first: treating infection, improving nutrition, controlling blood sugar and managing any incontinence or moisture.
• Stopping smoking is strongly advised, as smoking markedly raises the risk of the wound breaking down and the ulcer recurring.
• A specialist seating or pressure-relief assessment is usually arranged so the right cushion or mattress is in place for recovery.
• Tell the team about your mobility, spinal injury or other conditions, and how you transfer and sit.
• Plan for a long recovery, which often includes a period of strict bed rest and protected positioning after surgery.
• Discuss the realistic chance of healing first time and the risk of recurrence for your situation.
• Arrange the care and equipment you will need at home or in rehabilitation afterwards.

What happens

The operation is usually done under general anaesthetic, sometimes under a spinal or epidural. First the surgeon removes the ulcer and any dead, unhealthy or infected tissue, including affected bone if needed (debridement). This leaves a clean wound, often larger than the visible ulcer.

The surgeon then closes the wound by raising a flap — healthy skin, fat and sometimes muscle from an area nearby — and moving it over the defect while keeping its blood supply. The flap is stitched in place, and drains are often used to stop fluid collecting underneath. The choice of flap depends on the site and size of the wound.

This is reconstructive surgery done by a plastic surgeon, usually as part of a wider team including wound-care nurses, dietitians, physiotherapists, occupational therapists and rehabilitation specialists. Afterwards, careful positioning to keep all pressure off the repair is essential, which is why a planned, often prolonged recovery follows.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The two dominant issues are wound breakdown (dehiscence) and recurrence — overall complication rates in published series are high, and recurrence after flap surgery has ranged very widely between studies with no clear improvement over decades. Smoking, low body weight, poor nutrition, ongoing pressure and incontinence all worsen the odds. This is why surgery only works as part of a wider plan that tackles the cause. Ask the team about your personal risk of recurrence and exactly what positioning, seating and care you will need afterwards.

Published figures to discuss

Outcomes after pressure-sore surgery vary widely with the patient, the wound site, the flap used and — above all — whether the cause can be controlled afterwards. Published complication and recurrence figures differ greatly between studies and follow-up periods, so they should be read as a guide, not a personal prediction. Recurrence in particular is strongly tied to ongoing pressure, nutrition and smoking.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from pressure sore reconstruction is deliberately slow and protected. The flap needs to heal without any pressure on it, so a planned period of careful positioning — often including bed rest on a special mattress — is central, followed by a gradual, supervised return to sitting.

• A planned period of restricted positioning or bed rest after surgery
• Drains and dressings for a while as the flap heals
• A slow, scheduled build-up of sitting time
• Tiredness and the effects of a long recovery
• Ongoing focus on pressure relief, seating and nutrition

Aftercare

• Follow the positioning and bed-rest plan precisely — pressure on the healing flap is the main cause of failure.
• Reintroduce sitting only to the schedule the team gives you, building up gradually.
• Use the prescribed pressure-relieving mattress and seating cushion at all times.
• Keep up good nutrition and hydration, which are essential for healing.
• Manage moisture and incontinence carefully to protect the wound.
• Do not smoke, as it strongly impairs healing and raises recurrence.
• Check the skin regularly (or have a carer do so) for early signs of breakdown.
• Attend wound reviews and rehabilitation appointments and report problems early.

• Pressure-relieving mattress and the right seating cushion arranged
• A clear positioning and sitting-up schedule in writing
• Nutrition plan or dietitian input in place
• Help at home or a rehabilitation placement organised
• Incontinence and skin-care routine sorted
• Wound-care and rehabilitation appointments booked
• Team's contact number for problems saved

Scars and how they heal

There will be a scar where the flap was moved and the wound closed, usually over a pressure-bearing area such as the lower back, hip or sitting bone. Because these areas take pressure, the scar and suture line can be vulnerable to breakdown, which is why protected positioning matters so much. Scars usually mature over months. Tell the team if any part of the scar reddens, opens or feels different.

⚠ Get urgent help if…

• The wound opening up, leaking or the flap edge looking dusky, dark or pale
• Spreading redness, heat, swelling or discharge (signs of infection)
• A fever, shivering or feeling generally unwell (possible spreading infection)
• Increasing pain, or new pain, around the wound
• A new red or broken area of skin developing anywhere from pressure
• Calf pain, breathlessness or chest pain during the period of bed rest (possible clot)

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is a healed, durable closure over the pressure point that improves comfort, hygiene and the ability to sit, achieved alongside a workable long-term prevention plan. The wound is closed at surgery, but a stable, healed result takes weeks of protected recovery and depends heavily on keeping pressure off the area. Even with a technically good flap, healing problems and later recurrence are common, so success is measured over months and years, not at the operation. Honest teams set this out clearly.

How long a reconstruction lasts depends largely on whether the cause is controlled. Where pressure relief, seating, nutrition and skin care are maintained, a healed flap can last well. But the area remains vulnerable, and recurrence rates after pressure-sore surgery are high and vary widely, with previous pressure-ulcer surgery itself a risk factor for further ulcers. Lifelong prevention is the key to making the result last.

Combining with other procedures

Pressure sore reconstruction is one part of a wider package: debridement, treatment of infection, nutritional support, seating and pressure-relief assessment, physiotherapy and rehabilitation, and management of continence and spasticity. Where there is infected bone, that is treated too. Some people need staged surgery — debridement first, then reconstruction once the wound is clean and the patient optimised.

Follow-up & long-term care

Follow-up involves the surgical team for wound and flap checks and a rehabilitation and wound-care team for the longer recovery, seating and prevention plan. Sitting is reintroduced on a schedule with close skin monitoring. Because the area stays at risk, longer-term review and ongoing pressure care continue, with prompt attention to any early sign of breakdown.

• Keep using the prescribed pressure-relieving mattress and seating cushion
• Reposition or relieve pressure regularly as advised, for life
• Maintain good nutrition and manage moisture and incontinence
• Carry out regular skin checks to catch early breakdown
• Attend long-term reviews and act quickly on any new pressure area

Revision and secondary surgery reality

• Wound breakdown often needs further dressings, repeat debridement or re-operation.
• Recurrent or new ulcers may need further reconstruction, sometimes using a different flap.
• Some people have several procedures over the years as the area stays vulnerable.
• Each repeat operation can be more difficult as local tissue options reduce.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A clear, written positioning and graded sitting-up schedule with a named contact.
• Provision of the right pressure-relieving mattress and seating cushion.
• Dietitian and wound-care nurse involvement, with regular skin checks.
• Long-term rehabilitation and prevention support to reduce recurrence.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The surgeon's fee and the complexity of the wound and flap chosen
• Anaesthetic and a likely inpatient stay, sometimes prolonged
• Debridement and any treatment of infected bone
• Specialist mattresses, seating assessment and pressure-relief equipment
• Nutritional support, wound care and rehabilitation input
• Follow-up and treatment of any complications such as wound breakdown or recurrence

• The surgeon's fee and the facility/theatre fee
• Anaesthetic fee and the expected length of inpatient stay
• Cost of specialist mattress, seating and pressure-relief equipment
• Whether nutrition, wound-care and rehabilitation input are included
• Follow-up appointments over the prolonged recovery
• What happens, and who pays, if the wound breaks down or the ulcer recurs
• The cancellation policy

On the NHS? Pressure ulcers are managed on the NHS as part of wound care and rehabilitation, with reconstruction provided where appropriate; private pathways for this are uncommon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• What is my personal risk of the ulcer coming back, and how will we reduce it?
• Which flap do you plan to use, and why is it best for my wound?
• How long will I need to stay off the area, and what is the sitting-up schedule?
• What seating, mattress and nutrition support will be arranged?
• Will any bone need to be removed, and does that change the recovery?
• What is the plan if the wound breaks down or the flap partly fails?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for pressure sore reconstruction

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Pressure ulcers (pressure sores) NICE — Pressure ulcers: prevention and management (CG179) Flap reconstruction for pressure ulcers: an outcomes analysis — PRS Global Open Operative treatment of pelvic pressure sores: a 10-year overview — PMC Prevention of pressure ulcers in spinal cord injury — PMC

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.