Lefemine, V; Enoch, S; Boyce, D. E.
European Journal of Plastic Surgery, April 2009, Volume 32, Issue 2, pp 63-75

Despite significant advances in therapeutic options, pressure ulcers continue to pose a challenge to physicians and surgeons and frequently require multidisciplinary input. In addition, they place huge financial burdens on health care providers. Generally classified as grades I to IV depending on the extent and severity of the ulcer, grades I and II are usually amenable to conservative management. Grades III and IV may require surgical intervention, which could either be simple debridement or complex reconstructive microsurgery. Direct closure or skin grafting is useful in only a small number of early pressure ulcers. For non-healing and advanced pressure ulcers, reconstructive surgery is indicated, which consists of soft tissue flap coverage such as fasciocutaneous, musculocutaneous, perforator, or free flaps.