Flap reconstruction, or flap surgery, is a procedure a patient may need to cover an open wound in a serious bed sore case. Severe bed sores (stages three and four) can create open craters in the skin. A bed sore can extend deep into the underlying muscle and expose bone. Open wounds may have trouble healing without surgery. Flap reconstruction places a layer of healthy skin, harvested from elsewhere on the body, over the exposed area to facilitate healing.
Only severe pressure ulcers will need flap reconstruction. In less severe cases, treatment such as debridement of dead tissues is usually enough to promote skin healing. Healthy skin will spread over the wound naturally when uninhibited by necrotic tissues and infection. If a bed sore goes undiagnosed and untreated for too long, however, it may experience complications that can hinder natural healing, such as skin sloughing, ulcer recurrence, nonhealing, and infection. In these situations, flap reconstruction can be the best form of treatment.
Flap reconstruction surgery involves taking a piece of healthy skin from somewhere else on the body and surgically installing it to cover the exposed area of a bed sore. It serves to reconstruct the area of skin the bed sore damaged. It is similar to skin grafting, but uses a different technique. The new skin covers to the perimeter of the bed sore, after a physician debrides the original wound and defines its edges. The patient is unconscious and under anesthesia for the duration of flap reconstruction surgery.
Healing from flap reconstruction surgery will require months of recovery time, typically with a lot of bed rest. Complications after flap reconstruction can interfere with recovery, including wound dehiscence. Wound dehiscence is a wound rupture along the length of a surgical incision. Patients with diabetes, obesity, or trauma to the wound after surgery are most at risk of wound dehiscence. Another potential complication is bed sore recurrence. Recurrence of surgically treated bed sores may occur because of a change in the makeup of the cells in the area.
Infection is another possible complication of flap reconstruction. Proper post-operative care is critical in preventing infections in the area. Antibiotics, antimicrobial solutions, glean gauze bandages, and keeping the patient clean and dry can help prevent infections at the surgical site. If infection does occur, it can impede skin healing and may affect the blood, causing a life-threatening condition called sepsis. Diabetes is a risk factor for suffering wound infection after flap reconstruction.
If a patient does not experience complications post-operation, he or she can expect a complete recovery within a few months after the surgery. Patients often need special mattresses or air fluidizer beds to relieve pressure from the region during recovery. Medicare will cover special bed rentals for patients with stage three or four pressure ulcers. They may also need cushions, such as patient positioners or wedges in different areas of the body for pressure relief. Nurses should turn or reposition patients recovering from flap reconstruction regularly.
Flap reconstruction may be the final treatment option for a patient with a severe nonhealing pressure ulcer. Nonhealing ulcers may be too long, wide, or deep to heal on their own – especially if the site has an infection or inflammation. Flap reconstruction can provide the layer of strong, healthy skin the area needs to regrow nondamaged cells and stitch the wound back together.
Flap construction may not be right for every patient. A physician may recommend this route depending on numerous patient and injury factors. Patients with spinal cord injuries are the most common candidates for surgical pressure ulcer reconstruction. Successful flap reconstruction can prevent infections and decrease morbidity. Discuss your options and risk factors with a doctor to learn more about flap reconstruction.
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