Reconstructive ladder

Method	Description	Use Case
Primary Closure	Direct stitching of the wound edges together.	Small, clean wounds that can be easily brought together without tension.
Closure by Secondary Intention	The wound heals naturally without surgical closure.	Small wounds that can heal from the inside out, though it may result in larger scars and longer healing times.
Negative Pressure Wound Therapy (NPWT)	Uses a vacuum-sealed dressing to create negative pressure, promoting healing.	Wounds that benefit from reduced edema, increased blood flow, and stimulated granulation tissue formation.
Skin Graft	Transplanting skin from a donor site to the wound.	Wounds that cannot be closed directly but have a healthy enough bed to support a graft.
Dermal Matrices	Bioengineered scaffolds to replace or support the dermis.	Replacement or support of damaged or missing dermis, promoting cell regeneration.
Local Flaps	Tissue adjacent to the wound is used to cover the defect, keeping its blood supply.	Larger or more complex wounds where skin grafts might not be successful.
Regional Flaps	Tissue harvested from near the wound site, still connected to its blood supply, to cover defects.	Covering defects that cannot be closed by simpler means, utilizing nearby tissue segments.
Distant Flaps	Tissue from a different part of the body, transferred to the wound area.	Complex wounds not adjacent to usable tissue, requiring microvascular techniques to reattach blood vessels.
Free Flaps	The most complex method, transferring tissue along with its blood supply to the wound, requiring microvascular surgery.	Large or complex defects needing not just skin but possibly muscles, nerves, or bone reconstruction, especially when other methods are not viable.

Reconstructive ladder