Predictors of Successful Flap Reconstruction for Pressure Ulcers: A Retrospective Analysis of Patient and Ulcer Characteristics

Background Pressure ulcers are a major cause of morbidity in immobilized and debilitated patients. Advanced pressure ulcers often require flap reconstruction for durable wound coverage; however, postoperative complications and recurrence remain significant concerns. Identification of factors influencing flap survival and wound healing is important for improving surgical outcomes. Aim This study aimed to identify predictors of successful flap reconstruction in patients undergoing surgical management for pressure ulcers. Materials and methods A retrospective observational study was conducted in the Department of General Surgery, LN Medical College and JK Hospital, Bhopal, from November 2024 to November 2025. Twenty patients with Stage III and Stage IV pressure ulcers who underwent flap reconstruction were included. Patient-related factors, including age, sex, nutritional status, anemia, and comorbidities, were recorded. Ulcer-related variables, including site, stage, duration, infection, and osteomyelitis, were also analyzed. Different flap procedures, including the superior gluteal artery perforator (SGAP) flap, tensor fascia lata flap, bilateral V-Y advancement flap, and rotational flap, were performed according to ulcer characteristics. Postoperative outcomes, including flap survival, wound healing, complications, and recurrence, were assessed. Results The mean age of patients was 58.9 ± 10.6 years, with male predominance, accounting for 12 (60.0%) patients. Sacral ulcers were the most common ulcers observed, noted in 10 (50.0%) patients, followed by trochanteric ulcers in five (25.0%) patients. Most ulcers were Stage IV pressure ulcers, seen in 12 (60.0%) patients. Successful flap healing was achieved in all patients, with no recurrence noted during follow-up. Postoperative complications were observed in five (25.0%) patients and included seroma formation, wound dehiscence, partial flap necrosis, and abscess formation. Poor nutritional status (p = 0.01), anemia (p = 0.04), infection/osteomyelitis (p = 0.002), and prolonged ulcer duration (p = 0.03) were significantly associated with postoperative complications. Conclusion Flap reconstruction provides effective management for advanced pressure ulcers with favorable healing outcomes. Optimization of nutritional status, infection control, pressure off-loading, and management of comorbidities are essential factors that influence flap survival and reduce postoperative complications.