For pressure sore surgery, the surgeon you want is a qualified plastic and reconstructive surgeon who does flap work regularly, who examines the patient rather than a photograph, and who talks as much about mattresses, seating and nutrition as about the operation itself. That last point is the clearest signal of all. A surgeon who treats a bedsore as only a hole to be closed has not understood the problem you are living with.
Which qualifications actually matter?
In India, the recognised postgraduate qualifications in this field are M.Ch. in Plastic Surgery or DNB in Plastic Surgery, taken after a general surgery training. Ask directly which of these the surgeon holds and where it was obtained. It is a fair question and any honest surgeon will answer it without irritation.
Be careful with the word cosmetic. Plastic surgery covers both reconstructive and cosmetic work, and pressure sore repair sits firmly on the reconstructive side. Someone whose practice is entirely aesthetic may be an excellent surgeon and still not be the right person for a deep sacral wound with infected bone underneath. As an example of what the qualifications look like written out, Dr. Ashutosh Shah holds M.Ch. Plastic Surgery from The Maharaja Sayajirao University of Baroda and DNB from the National Board of Examinations, New Delhi, with more than 22 years of surgical experience, and practises both reconstructive and cosmetic surgery.
Does it matter how often the surgeon does this work?
Yes. Pressure sore reconstruction is not one standard operation. It is a family of techniques, and choosing between them depends on where the sore is, how deep it goes, what has been done before, whether the person may walk again and what tissue is still available if the repair has to be revised later. That judgement comes from doing the work often.
So ask how much reconstructive flap surgery the surgeon does, not only whether they can do it. Ask whether they routinely handle sores over the tailbone, the sitting bones and the hip, and what they do when a previous repair has already failed. Wider reconstructive and microsurgical experience is relevant too, because it means more options are on the table. Dr. Shah trained in microvascular surgery and replantation, has performed the highest volume of replantations among his cohort in Gujarat, and has taught more than 90 surgeons in hands on workshops as founder of Elegance Vidhyalaya.
What should you ask in the consultation room?
- Which operation are you proposing for this particular sore, and why that one rather than the alternatives.
- Does the bone need to be dealt with, and how will you know.
- Does this need to be done in stages, and what happens between the stages.
- What tissue will still be available if this repair fails and we need another attempt.
- What has to be true before you would operate, in terms of nutrition, infection, blood sugar and spasm.
- How long will the patient be lying flat, and when will sitting start.
- Who will guide the mattress, cushion and seating decisions.
- What is the plan if the wound opens after discharge, and who do we phone.
A good consultation feels like planning rather than selling. You should leave with a clear picture of stages, timelines, what is uncertain and what will be decided only once the wound is opened.
What are the warning signs?
Some answers should make you slow down and get a second opinion.
- A firm plan offered from a photograph on a phone, without examining the patient.
- No discussion at all of pressure relief, seating, nutrition or continence. This is the biggest warning sign of the lot.
- Promises about outcome, or a refusal to name any complication. Every version of this operation carries a chance of the wound opening, infection, fluid collection and recurrence.
- Pressure to admit today, or a discount that expires.
- Vagueness about who will actually perform the surgery.
- No written estimate before admission, or unwillingness to explain what is and is not included.
- Dismissing your questions about recurrence rather than explaining what makes it more or less likely.
Does the hospital and the wider team matter?
A great deal. This operation is won or lost in the ward as much as in theatre. Ask about the nursing setup for round the clock positioning, the availability of a suitable mattress, physiotherapy, dietetic input, and how continence will be managed while the wound heals. Ask whether the anaesthetic team is comfortable with patients who have spinal injury, poor nutrition or long standing illness.
Ask also about the practical things that will affect a family for weeks. Visiting and attendant policy, whether relatives will be trained in safe turning before discharge, how follow up is arranged, and how you reach the team between appointments.
How do you compare two opinions?
Getting a second opinion is normal and no reasonable surgeon minds. To compare fairly, carry the same information to both. That means dated photographs of the wound, the list of medicines, previous discharge summaries, wound swab and blood reports, and any imaging. Ask both surgeons the same core questions so you are comparing like with like.
Then judge on the reasoning rather than the confidence. The more useful opinion is usually the one that explains why a technique suits this wound, is honest about what could go wrong, is specific about the after care and does not pretend the outcome is certain. If one surgeon says the sore will need preparation before repair and the other offers immediate closure, ask the second one directly how they will manage infected bone, and listen carefully to the answer.
A practical way to decide
Write down, before you go in, the three things that matter most to your family. That may be avoiding a second operation, getting the person back into a wheelchair, or keeping the total time away from home manageable. Ask each surgeon how their plan addresses those three things. It turns a confusing choice into a comparison you can actually make, and it keeps the conversation on the patient rather than on the procedure.
Elegance Clinic is in Surat, Gujarat. Enquiries go to WhatsApp, and a written estimate is given before admission so families can plan.
