Pressure Ulcer · Stage-Based Conservative vs Flap Reconstruction

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Stage + healing/general condition
   Pressure ulcer stage? Wound status? Can the patient tolerate surgery?
   • Stage I–II → Stage I–II → offloading and dressings
   • Stage III–IV, clean granulation, can tolerate surgery → Stage III–IV clean → flap reconstruction
   • Stage III–IV with necrosis/infection → Stage III–IV necrosis → debride and control infection
   • Poor general condition/cannot tolerate surgery → Poor condition → palliative conservative
2. [End] Stage I–II → offloading and dressings
   Stage I–II → conservative: offloading (scheduled turning/pressure-relief surfaces), moist wound healing dressings, nutritional support, infection control; usually heals.
3. [End] Stage III–IV necrosis → debride and control infection
   Stage III–IV with necrosis/infection → debridement (sharp/enzymatic/biologic) + infection control + offloading + nutritional optimization; assess for reconstruction once clean granulation is achieved.
4. [End] Stage III–IV clean → flap reconstruction
   Stage III–IV, clean granulation, can tolerate surgery → flap reconstruction (myocutaneous/fasciocutaneous flap over the bony prominence), excising undermined cavities/bursae and the bony prominence; strict postoperative offloading to prevent recurrence.
5. [End] Poor condition → palliative conservative
   Poor general condition/cannot tolerate surgery → mainly conservative offloading, dressings, infection and pain control (palliative); optimize nutrition and comorbidities.

Source guidelines & references

• Pressure injury management (NPUAP/EPUAP/PPPIA international guideline; flap reconstruction)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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