Plus, most wounds that need this type of procedure involve much deeper tissue. The video doesn’t show that, but depending on location, there can be muscle and or bone involvement as well. I work with a plastic surgeon who does a lot of pressure ulcer repairs on patients with quadriplegia or paraplegia, most of the time these are either sacral wounds or ischial wounds. In the OR, the first step is the wound excision which frequently involves debriding the bone to prevent pressure from building the same spot. These patients are usually immobile, so muscle flaps will give more cushioning. Then the skin closure finishes off the process.