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Reconstructive Ladder in Plastic Surgery

The reconstructive ladder is a systematic approach used by plastic surgeons to guide wound reconstruction from least to most complex options. It includes allowing wounds to heal through secondary intention, direct closure if edges can be approximated without tension, skin grafting, local flaps, distant flaps, free tissue transfer, tissue expansion, and vacuum assisted closure therapy. The appropriate reconstruction method depends on factors like wound size, depth, presence of infection or dead tissue, and the patient's health and needs.

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Kay Bristol
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76 views11 pages

Reconstructive Ladder in Plastic Surgery

The reconstructive ladder is a systematic approach used by plastic surgeons to guide wound reconstruction from least to most complex options. It includes allowing wounds to heal through secondary intention, direct closure if edges can be approximated without tension, skin grafting, local flaps, distant flaps, free tissue transfer, tissue expansion, and vacuum assisted closure therapy. The appropriate reconstruction method depends on factors like wound size, depth, presence of infection or dead tissue, and the patient's health and needs.

Uploaded by

Kay Bristol
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

02/03/2017

The Reconstructive Ladder

A Presentation of The Plastic Surgery


Dep’t POSGH

What is it?

 A list of surgical options arranged in a rung


formation from the least to the most
complex.
 A systematic approach that guides the
plastic surgeon in wound reconstruction.

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Wound Assessment
 Size
 Depth
 Loss of tissues
 Injury to nerve,vessels,tendon ,bone
 Devitalised tissue
 Contamination
 Loss of function

Secondary Intention
 Myofibroblast proliferation and re-
epithelialisation.
 Useful if patient unfit/ refuses surgery
 Keep wounds moist
 Healing dependent on well vascularised
bed
 Process takes time

Direct Closure
 Debride wound edges
 Meticulous wound toilet
 Layered closure
 Avoid tension
 When in doubt DO NOT CLOSE
 Be mindful of tissue recoil

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Skin Graft
 Either partial or full thickness
 Taken from a donor site
 Survival is dependent on new vascularity
from its new bed (recipient site)
 Poor results with fat ,avascular wounds,
bone without periosteum,bare tendon and
cartilage

Flaps

 A block of tissue which has its own blood


supply.
 Moved from donor site to recipient site.
 Classified based on :
 blood supply
 pattern of movement
 tissue types

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Flaps

 Blood supply : Random pattern; Axial

 Movement: Local ;Distant; Free

 Tissue : skin, fascia , muscle, bone, or


combinations .

Random Pattern

Axial flap

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Free Tissue Transfer


 Movement of tissue from donor area to
recipient area .
 The survival is dependent on anastamoses
of vessels using microsurgical techniques.
 Requires time, expertise,equipment and
careful post-op monitoring.
 Can fail.

Tissue Expansion
 Mechanical process which increases surface
area of skin.

 The silicone expander is inserted in the


subcutaneous tissue adjacent to defect.

 Multiple inflations using saline.

Tissue Expansion
Advantages/Disadvantages

 No donor defect  Staged proceedure


 Ideal match  Painful
 Remains sensate  Unsightly bulge
 Inreased vascularity  Infection
 Extrusion

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Vacuum Assisted Closure


Therapy(V.A.C)
 Negative pressure (suction) applied to
wound
 Reduces oedema
 Increases granulation tissue formation
 Decreases bacterial count
 Assists wound contraction
 Increased vascularity

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WOUND HEALING
 No infection or dead tissue
 Good Hb
 Good nutrition-proteins
 Immaculate control of diabetes
 No underlying causes-vasculitis, venous,
decubitus etc.

Conclusion
 Reconstructive ladder is vital in wound
management.
 Assess wound and patient
 Many options available
 Carefully decide your choice
 Remember alternative options

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The end

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