Disparities in pressure ulcer flap reconstruction associated with barriers to accessing postoperative care

Background: Flap reconstruction for pressure ulcers remains a surgical challenge, requiring careful selection of suitable patients to optimise outcomes. Postoperative care, especially pressure offloading, is critical for the prevention of complications, which include failure of the skin flap and wound recurrence. While the rates and risks of postoperative complications have been acknowledged, the challenges of postoperative care have been largely unaddressed. Method: A 10-year retrospective review of all patients undergoing flap reconstruction for pressure ulcers at the College of Medicine (University of Florida, Florida, US) was conducted to elucidate factors that affected delays to discharge, post-discharge disposition (where the patient is discharged to), postoperative care and associated complications. Results: Among patients who underwent multiple separate reconstructions, disposition to home versus a skilled nursing facility (SNF) or long-term acute care hospital (LTACH) had a significant association with a higher risk of complications. Conclusion: In these high-risk patients, a multidisciplinary approach that would ideally be put in place preoperatively should be used to optimise postoperative care and prevent unnecessary prolonged hospitalisation.