Reconstructive Options in Wound Care: From Simplest to Most Complex

Despite significant advances, treatment for chronic ulcers remains challenging to clinicians and surgeons and, in addition, they demand many healthcare resources. Chronic wounds include diabetic foot, venous or arterial vascular leg, and pressure ulcers. Due to their complex etiology, they frequently require a multidisciplinary approach. It is critical to provide individualized patient assessment and treatment, preventing complications. Pressure ulcers are classified as grades I-IV depending on the extent and severity of the wound. Grades I and II are generally managed conservatively; instead, grades III and IV may need surgical procedures, from debridement to complex reconstruction. Simple surgical procedures such as direct closure and skin grafting are useful in early-stage ulcers. However, for advanced chronic pressure injuries, soft tissue flap coverage such as musculocutaneous, fasciocutaneous, and perforator-based flaps may be required. The selection of a proper reconstructive surgery depends on multiple factors, including ulcer location and grade, vascularization of adjacent tissues, patient mobility, and surgeon preference. This chapter provides an overview of the management and reconstructive modalities of complex chronic ulcers in various anatomical locations, including atypical location of pressure ulcers during the COVID-19 pandemic. Hence, particular emphasis has been given to current advances in reconstructive surgical procedures to achieve healing in such patients.