Pressure injury flap surgery in people with spinal cord injury/disorder: surgical and rehabilitation outcomes

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Published 5th June 2026

Study design
Retrospective chart audit.

Objectives
To describe the full range of complications in individuals with spinal cord injury or disorder (SCI/D) following flap repair of pelvic pressure injuries and explore factors associated with post-surgical complications.

Setting
Tertiary hospital Spinal Injuries Unit.

Methods
Data on 91 variables, including demographics, medical and surgical details, function, pre- and post-operative management, and complications were extracted for individuals admitted for flap surgery between 2015 and 2023. Descriptive and non-parametric analyses were performed.

Results
Sixty-one individuals with SCI/D underwent 84 flap surgeries during the study period. At discharge 95% could sit for at least 4 h with 50% tolerating more than 8 h, however 15% (n = 9/59) had reduced ability to transfer and 27% (n = 17/63) needed increased personal care support. Being overweight (Y/N) was significantly associated with a 54% increase in total complications (B = 0.43, SE = 0.22, IRR = 1.54, 95% CI [1.01, 2.35], p = 0.045), however diabetes (Y/N) was not. Local complications were positively associated with number of pressure injuries at admission, previous flap surgeries, length of stay, days from surgery to sitting and discharge, osteomyelitis, spasticity on admission, and increased pain. General complications were associated with diabetes and days from surgery to discharge.

Conclusions
Post-flap complications occur frequently, impacting rehabilitation progress and length of stay. By examining both local and general complications this study offers a broad-ranging view of the post-flap surgical and rehabilitation trajectory.

Citation
Zakharova-Luneva, E., Hogan, C., Jones, R., Kemp, J.-A., Allon, D., Yang, S., & Geraghty, T. (2026). Pressure injury flap surgery in people with spinal cord injury/disorder: Surgical and rehabilitation outcomes. Spinal Cord. https://doi.org/10.1038/s41393-026-01226-w

For more information about the broader project see: 
SEED PROJECT: Complications of post-flap surgery in people with spinal cord injury - Hopkins Centre

Authors

Tim Geraghty

Professor and Director

Christy Hogan

Research Fellow

Rachel Jones

Evgeniya Zakharova-Luneva

Rehabilitation Medicine Physician