The 'reconstructive ladder' in plastic surgery guides selection of wound closure technique in ascending order of complexity. Which technique is at the TOP of the traditional reconstructive ladder?

• A Split-thickness skin grafting
• B Free flap (microvascular tissue transfer) ✓
• C Full-thickness skin grafting
• D Local flap

Explanation

The reconstructive ladder ascends in complexity: primary closure → healing by secondary intention → split-thickness graft → full-thickness graft → local/regional random flap → axial pattern flap → distant pedicled flap → free flap (microvascular anastomosis). Free flaps represent the most complex reconstructive option, requiring microsurgical anastomosis of the flap's vessels to recipient vessels, but offer the best tissue match and viability for complex defects. The 'reconstructive elevator' concept suggests sometimes directly choosing the optimal method rather than climbing each step.

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.