The Rollin' RN's

Pressure Sores and the Flap Surgery Option

Recently, the question came up, “What is flap surgery?”

In a nutshell, it’s a surgical procedure where a piece of healthy skin from another area of the body is used to cover and reconstruct the exposed and damaged area of a bedsore. What it is not, is a simple once and done procedure. Flap reconstructive surgery takes meticulous care following the procedure until healing is complete and the area is ready for sitting again.

This procedure requires a serious discussion between a physician and the individual considering this option and should include:

• Location of pressure sore to be treated • Location of the flap skin to be taken • Plan for postoperative relief of pressure on the flap • Plan for postoperative relief of involuntary muscle spasms as necessary To improve the chances of successful flap surgery: • Acute infections should be fully treated prior to surgery to prevent damage to a new flap. • The patient’s nutritional status should be optimized to encourage tissue growth. • Patients should be encouraged to stop smoking, drinking alcohol, or using illicit drugs in an effort to improve wound healing.

Flap surgery may be an option to speed up the healing of a pressure sore but it’s not the only option. For many, flap surgeries work well with tedious follow-up care but many have a very high failure rate in the adult population, with statistics revealing an incidence between 25% and 85%.

Take your time, weigh the benefits, talk to your peers, and make an informed decision based on your own investigation.

The period after flap surgery is a critical time to achieve optimal healing. The patient must follow a strict regimen that starts with very limited sitting that may be resumed 6 weeks after a wound has healed.

The following is a sample schedule when sitting on a wheelchair cushion has been approved by your physician and is gradually reintroduced over several weeks:

• First Day: Begin sitting 10 minutes three times per day. These periods of time may not be added together to form 30 minutes once a day • After careful skin inspection, next increase in time: If there is no redness of the incision or flap, sitting can increase to 20 minutes three times per day • After careful skin inspection, next increase in time: If there is no redness of the incision or flap, the patient may increase sitting to 30 minutes three times per day • After careful skin inspection and assessment, next increase in time: If there is no redness of the incision or flap, the patient may increase sitting to 45 minutes three times per day • After careful skin inspection and assessment, next increase in time: If there is no redness of the incision or flap, the patient may keep advancing the amount of sitting time until they reach 2 hours three times per day. Do not advance beyond 2 hours at a time.

Carefully take into consideration your discussions with your doctor, your peers, and those that will be helping with your care to decide if flap surgery is right for you so you can get back to rolling again.

It’s all good, so keep on rollin’!

Patty, BSN, RNC and Roberta, RN The Rollin’ RNs ™

References: Flap coverage of pressure sores. https://www.clinicalpainadvisor.com/.../flap-coverage-of.../. Pressure Injuries and Flap Surgery. https://www.woundsource.com/.../pressure-injuries-and... Ten Top Tips: Improving Outcomes from Flap Reconstruction. https://www.woundsinternational.com.

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