Answer:
The basic tenets of surgical treatment of pressure sores have remained essentially unchanged. They are:
-excision of ulcer, surrounding scar, underlying bursa, and soft tissue calcifications, if present.
–radical removal of underlying bone and any heterotopic ossification.
-padding of bone stumps and filling in dead space with fascia or muscle flaps.
-resurfacing with large, regional pedicled flap.
-grafting the donor site of the flap with thick split skin, if applicable.
There are two principles of flap design:
1. A flap should be designed as large as possible, placing the suture line away from the area of direct pressure.
2. The flap design should not violate adjacent flap territories so as to preserve all options for coverage in the event of subsequent breakdown or if recurrence dictates further reconstruction.