In the reconstructive ladder for wound closure, the principle of using the simplest effective method first means that after considering direct closure, the next rung is:

• A Skin grafting (split-thickness or full-thickness)
• B Local flap
• C Healing by secondary intention ✓
• D Free tissue transfer

Explanation

The reconstructive ladder from simplest to most complex proceeds as follows: (1) healing by secondary intention, (2) primary closure / delayed primary closure, (3) skin grafting (split-thickness or full-thickness), (4) tissue expansion, (5) local flap, (6) regional flap, (7) distant flap, (8) free tissue transfer (microsurgical flap). After primary closure, the next simplest option is allowing healing by secondary intention, not skin grafting. The surgeon ascends the ladder only when lower rungs are unsuitable for the wound type or location.

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.