Pressure Ulcers and Wound Healing — Biology, Shear Forces, and Flap Reconstruction

Episode DescriptionThis episode reviews the core principles of wound healing and pressure ulcer (decubitus ulcer) reconstruction, focusing on the biology, biomechanics, and surgical decision-making required for successful treatment.Topics include the phases of wound healing, key mediators such as PDGF, TGF-β, and VEGF, and why chronic wounds fail—particularly in the setting of diabetes and ischemia. The episode also explains the physics of pressure injury, including the critical role of shear forces and the concept of “inside-out” tissue necrosis.Clinical staging using the NPUAP system (Red, Bed, Fat, Bone) is reviewed, along with essential preoperative principles such as nutritional optimization, glycemic control, and diagnosis of osteomyelitis.Reconstructive strategies are discussed by anatomic region, including TFL flaps, posterior thigh flaps, and gluteal-based reconstruction, with emphasis on durability and recurrence prevention.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.Topics Covered pressure ulcer pathophysiology shear vs friction plastic surgery, HIF-1 alpha VEGF angiogenesis wound healing phases PDGF TGF beta, NPUAP staging red bed fat bone deep tissue injury DTI, capillary closing pressure 32 mmHg decubitus ulcers biomechanics, osteomyelitis jamshidi biopsy vs swab MRI diagnosis, tensor fascia lata flap trochanteric ulcer sensate reconstruction, gluteus maximus flap sacral ulcer vs perforator flap ambulatory patient, hamstring V-Y ischial ulcer reconstruction, plastic surgery board review wound healingDisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.