The reconstructive ladder is a term coined by reconstructive plastic surgeons to describe levels of increasingly complex management of wounds. The surgeon should start on the lowest rung and move up until a suitable technique is arrived at.

The ladder

There are several small variations in the reconstructive ladder in the scientific literature, but the principles remains the same:

Rung 1: Healing by secondary intention

Rung 2: Primary closure

Rung 3: Delayed primary closure

Rung 4: Split thickness graft

Rung 5: Full thickness skin graft

Rung 6: Tissue expansion

Rung 7: Random flap

Flap (surgery)

Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is similar to but different from a graft, which does not have an intact blood supply and therefore relies on growth...

Rung 8: Axial flap

Rung 9: Free flap