A reconstruction ladder guides selection of wound coverage techniques in plastic surgery. The reconstructive ladder places which technique at the highest rung (most complex)?

• A Split-thickness skin graft (STSG)
• B Local flap
• C Secondary intention healing
• D Free flap (microvascular tissue transfer) ✓

Explanation

The reconstructive ladder (from simplest to most complex): secondary intention → primary closure → skin graft (STSG then FTSG) → local flap (random/axial) → regional/pedicled flap → free flap (microvascular anastomosis). Free flaps represent the most technically demanding rung, requiring microsurgical anastomosis of donor vessels, but offer the greatest versatility in defect reconstruction, particularly for complex three-dimensional wounds with exposed bone, tendon, or hardware.

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.