The Reconstructive Ladder for wound closure is, from simplest to most complex:

• A Primary closure → skin graft → local flap → pedicled flap → free flap
• B Secondary intention → delayed primary closure → primary closure → skin graft → local flap → pedicled flap → free flap ✓
• C Primary closure → secondary intention → split-thickness graft → full-thickness graft → local flap → free flap
• D Wound vacuum → split-thickness graft → pedicled flap → free flap → amputation

Explanation

The Reconstructive Ladder progresses from simplest to most complex: secondary intention → delayed primary closure → primary closure → skin graft (split then full thickness) → local flap → regional pedicled flap → free tissue transfer (microsurgical free flap). The surgeon should choose the simplest reliable option appropriate for the wound defect, tissue requirements, and patient factors. Negative pressure wound therapy (NPWT) is sometimes added as a rung between secondary intention and skin graft.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.