The reconstructive ladder principle prioritises which approach as the first option before escalating to complex reconstruction?

• A Free tissue transfer
• B Primary closure or healing by secondary intention ✓
• C Random pattern local flap
• D Skin grafting (split-thickness)

Explanation

The reconstructive ladder guides wound management from simplest to most complex: secondary intention healing → primary closure → delayed primary closure → split-thickness skin graft → full-thickness skin graft → tissue expansion → local flap → pedicled flap → free flap. The principle is to use the simplest reliable option first. However, clinical judgment may dictate starting higher on the ladder if simpler options are inappropriate (reconstructive elevator concept).

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.