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  • Reconstructive Ladder

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    Kay Bristol
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    The reconstructive ladder is a systematic approach used by plastic surgeons to guide wound reconstruction from least to most complex options. It includes allowing wounds to heal through secondary intention, direct closure if edges can be approximated without tension, skin grafting, local flaps, distant flaps, free tissue transfer, tissue expansion, and vacuum assisted closure therapy. The appropriate reconstruction method depends on factors like wound size, depth, presence of infection or dead tissue, and the patient's health and needs.

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    The reconstructive ladder is a systematic approach used by plastic surgeons to guide wound reconstruction from least to most complex options. It includes allowing wounds to heal through secondary intention, direct closure if edges can be approximated without tension, skin grafting, local flaps, distant flaps, free tissue transfer, tissue expansion, and vacuum assisted closure therapy. The appropriate reconstruction method depends on factors like wound size, depth, presence of infection or dead tissue, and the patient's health and needs.

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    64 views11 pages

    Reconstructive Ladder

    Uploaded by

    Kay Bristol
    The reconstructive ladder is a systematic approach used by plastic surgeons to guide wound reconstruction from least to most complex options. It includes allowing wounds to heal through secondary intention, direct closure if edges can be approximated without tension, skin grafting, local flaps, distant flaps, free tissue transfer, tissue expansion, and vacuum assisted closure therapy. The appropriate reconstruction method depends on factors like wound size, depth, presence of infection or dead tissue, and the patient's health and needs.

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    of 11

    02/03/2017

    The Reconstructive Ladder

    A Presentation of The Plastic Surgery


    Dep’t POSGH

    What is it?

     A list of surgical options arranged in a rung


    formation from the least to the most
    complex.
     A systematic approach that guides the
    plastic surgeon in wound reconstruction.

    1
    02/03/2017

    Wound Assessment
     Size
     Depth
     Loss of tissues
     Injury to nerve,vessels,tendon ,bone
     Devitalised tissue
     Contamination
     Loss of function

    Secondary Intention
     Myofibroblast proliferation and re-
    epithelialisation.
     Useful if patient unfit/ refuses surgery
     Keep wounds moist
     Healing dependent on well vascularised
    bed
     Process takes time

    Direct Closure
     Debride wound edges
     Meticulous wound toilet
     Layered closure
     Avoid tension
     When in doubt DO NOT CLOSE
     Be mindful of tissue recoil

    2
    02/03/2017

    Skin Graft
     Either partial or full thickness
     Taken from a donor site
     Survival is dependent on new vascularity
    from its new bed (recipient site)
     Poor results with fat ,avascular wounds,
    bone without periosteum,bare tendon and
    cartilage

    Flaps

     A block of tissue which has its own blood


    supply.
     Moved from donor site to recipient site.
     Classified based on :
     blood supply
     pattern of movement
     tissue types

    3
    02/03/2017

    Flaps

     Blood supply : Random pattern; Axial

     Movement: Local ;Distant; Free

     Tissue : skin, fascia , muscle, bone, or


    combinations .

    Random Pattern

    Axial flap

    4
    02/03/2017

    Free Tissue Transfer


     Movement of tissue from donor area to
    recipient area .
     The survival is dependent on anastamoses
    of vessels using microsurgical techniques.
     Requires time, expertise,equipment and
    careful post-op monitoring.
     Can fail.

    Tissue Expansion
     Mechanical process which increases surface
    area of skin.

     The silicone expander is inserted in the


    subcutaneous tissue adjacent to defect.

     Multiple inflations using saline.

    Tissue Expansion
    Advantages/Disadvantages

     No donor defect  Staged proceedure


     Ideal match  Painful
     Remains sensate  Unsightly bulge
     Inreased vascularity  Infection
     Extrusion

    5
    02/03/2017

    Vacuum Assisted Closure


    Therapy(V.A.C)
     Negative pressure (suction) applied to
    wound
     Reduces oedema
     Increases granulation tissue formation
     Decreases bacterial count
     Assists wound contraction
     Increased vascularity

    6
    02/03/2017

    7
    02/03/2017

    8
    02/03/2017

    9
    02/03/2017

    WOUND HEALING
     No infection or dead tissue
     Good Hb
     Good nutrition-proteins
     Immaculate control of diabetes
     No underlying causes-vasculitis, venous,
    decubitus etc.

    Conclusion
     Reconstructive ladder is vital in wound
    management.
     Assess wound and patient
     Many options available
     Carefully decide your choice
     Remember alternative options

    10
    02/03/2017

    The end

    11

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