Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group.
Samir S Awad, James D Stern, Cathy T Milne and 8 others
PMID 37079788WHAT IT FOUND
Expert consensus proposes a surgical algorithm for stage 3 and 4 pressure injuries, prioritizing patient optimization and interprofessional care.
It recommends negative-pressure wound therapy and bioscaffolds to manage complications, though no controlled trials support these specific surgical pathways.
Key findings
01The working group proposed a structured algorithm for surgical reconstruction of stage 3 and 4 pressure injuries to reduce complications and improve closure rates.
02Patient optimization, including high-protein nutrition supplements and nicotine cessation, was identified as a key preoperative factor supported by evidence from high-quality randomized controlled trials.
03Negative-pressure wound therapy is considered the criterion standard for management, with evidence supporting its use to shorten healing time and reduce costs.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The algorithm is based on expert consensus and a narrative review, not on new clinical trials or systematic reviews. There is a lack of contemporary controlled studies comparing different surgical reconstruction techniques. The working group did not include a rehabilitation expert or a dietitian, limiting the scope of postoperative care recommendations. Evidence for bioscaffolds in surgical reconstruction is sparse, with only three case series identified.
Declared interests
The authors disclosed no other financial relationships related to this article.
The easy way to misread this
Do not treat this algorithm as evidence that specific surgical techniques or bioscaffolds are superior. The authors state there are no clear recommendations for preferred surgical management due to limited clinical data, and this proposal is intended only to guide future evidence gathering.