The first week after pressure sore reconstruction is mostly about one thing. Keeping every gram of weight off the new repair while it settles. Expect the person to be nursed in set positions, to have one or more drains, to be on antibiotics and pain relief, and to stay in hospital rather than going home. Very little of the week is dramatic. Most of it is careful, repetitive nursing, and the family who understand why it is being done make it go far better.
What happens straight after the operation?
The person comes back from theatre with a dressing over the repaired area and usually a soft tube or two draining fluid from underneath it. Blood pressure, pulse, temperature and urine output are watched closely. Fluids and antibiotics are given through a vein at first. If a general anaesthetic was used, drowsiness and a dry throat for a few hours are normal.
The nursing team will already have a positioning plan written down before the person leaves theatre. Ask to see it on day one and take a photograph of it. Knowing exactly which sides the person may lie on, and for how long, prevents the well meant mistake of propping them up on the wrong hip because they looked uncomfortable.
Why is positioning the whole of the first week?
A flap survives on the blood supply carried in with it. Pressure squeezes those small vessels shut. Even a short period of the person sitting back on the repair, or sliding down the bed onto it, can damage tissue that was healthy an hour earlier. That is why the rules feel strict.
In practice this usually means lying flat or turned to permitted sides, changed on a fixed schedule around the clock, on a specialised mattress. Sitting is usually not allowed at all in the early days. The head of the bed is often kept low, because raising it makes the body slide and shear the tissue. Feeding, washing and physiotherapy are all arranged around those positions rather than the other way round.
What about the drains and the dressing?
Drains remove the fluid that naturally collects under a flap. If that fluid is allowed to build up, it lifts the repair off its bed and invites infection. Drains stay in until the amount coming out falls to a level the surgeon is happy with, which is judged case by case rather than by a fixed day. Do not pull, kink or lift the tubing when helping with turns, and tell the nurse if a drain stops running or the bag suddenly fills with fresh blood.
The dressing is usually left undisturbed for the first days unless there is a reason to look. The team check the colour and warmth of the flap regularly. A repair that is dusky, cold, very swollen or leaking heavily is reported at once, because early problems are often fixable if caught early.
Will there be pain, and how is it controlled?
There is usually discomfort at the donor area and around the wound, and it is treated actively with regular medicines rather than waiting for the person to ask. People who have reduced sensation from a spinal injury may feel little at the wound itself but can still get spasms, headache, sweating or a rise in blood pressure, which must be reported because they can signal a problem elsewhere such as a blocked catheter.
Muscle spasm deserves special attention in the first week. A strong spasm can jerk the hip or thigh and tear a fresh repair. If the person has a history of spasms, say so before surgery so that medication is planned in advance.
How are bowels, bladder and skin managed?
Keeping the wound clean is a large part of week one, especially for sores near the tailbone. Expect a urinary catheter for a while, and expect the team to have a plan for the bowels, which may include diet changes, medication or a period of low residue feeding. Soiling of the dressing is dealt with promptly rather than left.
Meanwhile the rest of the skin needs watching. The heels, the elbows, the shoulder blades, the ears and the side of the knee take the load while the usual positions are off limits, and new sores can appear in those places during this very week. Ask the nurses to show you what to check and check it yourself at every turn.
What can the family usefully do in week one?
- Learn the turning schedule and help keep it, including at night. Consistency matters more than effort.
- Learn how to move the person by lifting rather than dragging, so the skin is not sheared.
- Encourage food and fluids. Protein, calories and hydration are doing real work on the wound. Report it if the person is eating almost nothing.
- Watch the unprotected pressure points and speak up early if any area stays red after the pressure is removed.
- Keep the drains and catheter tubing free and visible during every move.
- Write down your questions for the ward round rather than trying to remember them.
What should be reported without waiting?
Call the nurse straight away for fever, shaking chills, a sudden rise in drain output or fresh bleeding, a foul smell, spreading redness, a dressing that becomes soaked, severe new pain, a flap that looks dark or feels cold, uncontrolled spasms, or new confusion. If you are already home and any of these appear, along with breathlessness, chest pain or a very fast pulse, go to an emergency department now rather than waiting for the next clinic visit.
Ending the week
By the end of the first week most people are stable, still lying rather than sitting, with drains either removed or reducing, and with the team beginning to talk about the longer plan. Sitting is reintroduced later and gradually, on the surgeon's instruction, never on the family's judgement. The clinic will give written guidance before discharge, and it is worth reading it together with everyone who will be sharing the care at home.
