reconstructive ladder

The reconstructive ladder is the set of levels of increasingly complex management of wounds in reconstructive plastic surgery.ABC of wound healing: BMJ 2006;332;710-712 Reconstructive surgery, D. E. Boyce, K. Shokrollahi The surgeon should start on the lowest rung and move up until a suitable technique is reached.

There are several small variations in the reconstructive ladder[http://student.bmj.com/back_issues/0803/education/271.html sBMJ]Orthop Clin North Am. 1993 Jul;24(3):393-409, The reconstructive ladder. An orthoplastic approach, L. Levin in the scientific literature, but the principles remains the same:

1. Healing by secondary intention
2. Primary closure
3. Delayed primary closure
4. Split thickness graft
5. Full thickness skin graft
6. Tissue expansion
7. Random flap
8. Axial flap
9. Free flap