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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


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