What to Expect if a Pressure Ulcer Requires Flap Surgery

A pressure ulcer is a devastating condition.  They occur when the constant pressure applied to skin and tissue goes unrelieved for extended periods of time.  This is why the doctors, nurses and therapists talk about the importance of doing pressure lifts and weight shifts very often to relieve this compression.  The tissue must have pressure relief or tissue injury will occur and flap surgery may be the result.  A flap surgery is followed by months of recovery and very little time out of bed.

This is a sample of what to expect if a pressure ulcer is so severe that a flap surgery is needed.

The following is a post taken from a public forum written by the nurse moderator for the forum site.  The nurse explains the protocol at her facility following flap surgery.

Her reply below is in response to a question asking about protocol after a flap surgery.

“It would be much better if you could get onto a LAL (low air loss) mattress now (which would mean also getting a hospital bed frame). We also require these for 6 months after the surgery when you return home. Medicare will cover rental of both if you have a documented stage III or IV pressure ulcer.

Post op if you will be on an air fluidized bed, for how long? How long will you be able to stay in the acute care hospital before they have to move you to a nursing home? Most often it is a maximum of 10 days in the acute care hospital, esp. with Medicare as your primary insurance. 

While on an air fluidized bed you would need to do bowel care on your side, and have someone else do it…I have had too many clients contaminate their wound or even stick a finger through the incision of the flap doing bowel care, so we do not allow that on my unit, and the nurses must do your bowel care for you with you on your side, on Chux (never a bed pan). 

On an air fluidized bed you would not be prone (it doesn’t work…can’t breathe), but supine (on your back) and side to side, with no head of bed elevation, which can make eating and taking pills a challenge for some. Once you get moved to a LAL mattress (for us, this is no sooner than the 5th week) then you can start to prone. Bowel care is still best done on your side. We don’t allow the use of a well-padded commode for bowel care until you are into the sitting program, have at least 2 hours of sitting time, and the commode time is counted as part of your sitting program time allowed.

Another post from the sci nurse on the same forum site.

“Our protocol is flat lying in a clinitron for 6 weeks, then using wedge for 2 weeks, then up in chair once daily for 15 min and increase by 15 min every 2 days.

All of this hardship, the flap surgery and the long restrictive recovery could be repeated if there is another pressure injury.  This can happen if the patient sits on the same cushion that gave them the first injury unless they are diligent and follow the doctors order about doing pressure lifts every 15 minutes. 

There is a way to derive the benefit of pressure lifts without having to take any action yourself and that is by using our automatic alternating custom wheelchair cushions.