Is Primary Closure Safe and Effective for Sacral Pressure Ulcers? Single-Surgeon Experience With Negative Pressure Wound Therapy in a Medical Center and a Regional Hospital

BACKGROUND: Sacral pressure ulcers present a major reconstructive challenge, especially in elderly and bedridden patients. Although negative pressure wound therapy (NPWT) has been widely used in wound management, its integration into surgical protocols for pressure ulcer closure is underreported in midlevel medical centers. We aimed to evaluate the safety, efficacy, and reproducibility of a streamlined surgical strategy for sacral pressure ulcers combining debridement, primary closure, and closed-incision-NPWT (CI-NPWT) and examine the outcomes in patients treated in 2 institutional settings with different resource levels. METHODS: This retrospective observational cohort study included 35 patients (median age, 76 years; 66% female) with stage III-IV sacral pressure ulcers who underwent surgical reconstruction using a standardized approach involving debridement, tension-reducing wound closure, and CI-NPWT. All procedures were performed by a single reconstructive surgeon at both a medical center and a regional hospital. RESULTS: Among the 35 patients, 33 were treated at the tertiary center and 2 at the regional hospital. The median wound size was 9 × 6 cm (range 3 × 5-13 × 12 cm). Most patients were elderly with multiple comorbidities. CI-NPWT effectively supported primary wound closure with no major complications. Minor wound-edge dehiscence occurred in a few patients and was managed conservatively. All wounds healed completely. CONCLUSION: A simple and consistent surgical protocol combining primary closure with CI-NPWT is safe, effective, and reproducible in both medical center and regional hospital settings.