title: Benefits of surgical reconstruction in pressure ulcers with a non-advancing edge and scar formation.
abstract: OBJECTIVE
  To highlight the difficulty in treating pressure ulcers associated with scar formation and the benefits of surgical treatment in these cases by presenting a series of clinical cases.
  
  
  METHODS
  Nine sacral ulcers surrounded by significant scar formation and 14 sacral ulcers without significant scars were treated using the same conservative management protocol. Healing status was quantitatively estimated using an assessment tool called DESIGN, which classifies pressure ulcer severity and allows healing to be monitored; a decreasing score indicates progressive improvement.
  
  
  RESULTS
  Ulcers with scar formation showed little response to the treatment, while those without remarkable scars exhibited a significant decrease of the DESIGN scores. Surgical reconstruction was conducted in five ulcers surrounded by scar formation, and all showed complete healing within extremely short periods.
  
  
  CONCLUSIONS
  Conservative treatment of pressure ulcers with a non-advancing edge surrounded by scar formation presents considerable difficulties. Surgical reconstruction offers many benefits for non-healing ulcers.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Saitama Medical School, Saitama, Japan. ichioka-stm@umin.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Ichioka
authors.forename: N
authors.initials: N
authors.lastname: Ohura
authors.forename: T
authors.initials: T
authors.lastname: Nakatsuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D002921:Cicatrix / Q000209:etiology / Q000451:nursing / Q000601:surgery*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods / Q000451:nursing; D003668:Pressure Ulcer / Q000150:complications / Q000451:nursing / Q000601:surgery*; D012720:Severity of Illness Index; D017592:Skin Care / Q000379:methods / Q000451:nursing; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing