Reconstructive ladder

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]

Overview
The reconstructive ladder is a term coined by reconstructive plastic surgeons to describe levels of increasingly complex management of wounds.

The ladder
There are several small variations in the reconstructive ladder 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 pattern flap

Rung 8: pedicled flap

Rung 9: free flap