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Moving beyond anatomical closure, the field now prioritises functional\u2010integrated reconstruction. This paradigm emphasises radical debridement and the transfer of well\u2010vascularized perforator flaps to obliterate dead space, cover wounds, and restore protective sensation, aiming to break the recurrence cycle and restore patient autonomy. This review critically synthesises contemporary advances driving this shift. It details the development of precision and minimally invasive perforator flap techniques, including sensory nerve coaptation and chimeric designs. The integration of multimodal perioperative strategies, such as antibiotic\u2010loaded bone cement and fluorescence angiography, is discussed. The adjunctive role of traditional Chinese medicine and the exploratory potential of regenerative approaches (stem cells, 3D\u2010bioprinting) are considered. Finally, practical recommendations for implementing this holistic approach are provided, along with a clinical flowchart to guide staged management. By consolidating these advances, this review provides a framework to transition IPU management from simple wound healing towards comprehensive functional and social rehabilitation.<\/jats:p>","DOI":"10.1111\/wrr.70184","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:49:59Z","timestamp":1782917399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ischial Pressure Ulcer Reconstruction: A Critical Review of the Paradigm Shift From Wound Coverage to Functional Restoration"],"prefix":"10.1111","volume":"34","author":[{"given":"Chengying","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Emergency Sanming Integrated Medicine Hospital  Sanming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohua","family":"Wang","sequence":"additional","affiliation":[{"name":"Burn and Wound Repair Department Fujian Burn Institute, Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jielong","family":"Lin","sequence":"additional","affiliation":[{"name":"Burn and Wound Repair Department Fujian Burn Institute, Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunbin","family":"Wang","sequence":"additional","affiliation":[{"name":"Burn and Wound Repair Department Fujian Burn Institute, Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaorong","family":"Xu","sequence":"additional","affiliation":[{"name":"Burn and Wound Repair Department Fujian Burn Institute, Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/life15020146"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2019.28.11.702"},{"issue":"10","key":"e_1_2_14_4_1","first-page":"34","article-title":"Are All Pressure Ulcers the Result of Deep Tissue Injury? 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