Reconstructive ladder

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The reconstructive ladder is a term coined by reconstructive plastic surgeons to describe levels of increasingly complex management of wounds.[1] The surgeon should start on the lowest rung and move up until a suitable technique is arrived at.

The ladder[edit]

There are several small variations in the reconstructive ladder[2][3] in the scientific literature, but the principles remains the same:

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


  1. ^ ABC of wound healing: BMJ 2006;332;710-712 Reconstructive surgery, D. E. Boyce, K. Shokrollahi
  2. ^ sBMJ
  3. ^ Orthop Clin North Am. 1993 Jul;24(3):393-409, The reconstructive ladder. An orthoplastic approach, L. Levin

See also[edit]