Reconstructive ladder

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The reconstructive ladder is the set of levels of increasingly complex management of wounds in reconstructive plastic surgery. [1] The surgeon should start on the lowest rung and move up until a suitable technique is reached.

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two categories. The first is reconstructive surgery which includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. The other is cosmetic or aesthetic surgery. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims at improving the appearance of it. Both of these techniques are used throughout the world.

There are several small variations in the reconstructive ladder [2] [3] in the scientific literature, but the principles remains the same:

  1. Healing by secondary intention
  2. Primary closure
  3. Delayed primary closure
  4. Split thickness graft
  5. Full thickness skin graft
  6. Tissue expansion
  7. Random flap
  8. Axial flap
  9. Free flap

See also

Related Research Articles

Breast reconstruction

Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple. This procedure involves the use of implants or tissue taken from other parts of the woman's body.

Scar area of fibrous tissue that replaces normal skin after an injury

A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs and tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. An exception to this are animals with complete regeneration, which regrow tissue without scar formation.

Rhinoplasty A surgical procedure to enhance or reconstruct a human nose.

Rhinoplasty, commonly known as a nose job, is a plastic surgery procedure for correcting and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that improves the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery also treats birth defects, breathing problems, and failed primary rhinoplasties. Most patients ask to remove a bump, narrow nostril width, change the angle between the nose and the mouth, as well as correct injuries, birth defects, or other problems that affect breathing, such as deviated nasal septum or a sinus condition.

Tissue expansion is a technique used by plastic, maxillofacial and reconstructive surgeons to cause the body to grow additional skin, bone, or other tissues. Other biological phenomena such as tissue inflammation can also be considered expansion.

Phalloplasty is the construction or reconstruction of a penis, or the artificial modification of the penis by surgery. The term phalloplasty is also occasionally used to refer to penis enlargement.

Skin grafting

Skin grafting is a type of graft surgery involving the transplantation of skin. The transplanted tissue is called a skin graft.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

Reconstructive surgery MUHAHA!>:-}

Reconstructive surgery is, in its broadest sense, synonymous with plastic surgery. Commonly, however, reconstructive surgery is understood as the use of surgery to restore the form and function of the body, which does not include aesthetic or cosmetic surgery. For example, plastic surgeons, maxillo-facial surgeons and otolaryngologists do reconstructive surgery on faces after trauma and to reconstruct the head and neck after cancer.

The terms free flap, free autologous tissue transfer and microvascular free tissue transfer are synonymous terms used to describe the "transplantation" of tissue from one site of the body to another, in order to reconstruct an existing defect. "Free" implies that the tissue is completely detached from its blood supply at the original location and then transferred to another location and the circulation in the tissue re-established by anastomosis of artery(s) and vein(s). This is in contrast to a "pedicled" flap in which the tissue is left partly attached to the donor site ("pedicle") and simply transposed to a new location; keeping the "pedicle" intact as a conduit to supply the tissue with blood.

Mastopexy is the plastic surgery mammoplasty procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding.

Subepithelial connective tissue graft

In dentistry, the subepithelial connective tissue graft is an oral and maxillofacial surgical procedure first described by Alan Edel in 1974. Currently, it is generally used to obtain root coverage following gingival recession, which was a later development by Burt Langer in the early 1980s.

David Ralph Millard, Jr. was a plastic surgeon who developed several techniques used in cleft lip and palate surgeries. He was chief of the Division of Plastic Surgery at University of Miami's Miller School of Medicine for 28 years, and maintained a private practice in Miami.

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration. Guided bone regeneration typically refers to ridge augmentation or bone regenerative procedures; guided tissue regeneration typically refers to regeneration of periodontal attachment.

In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery. The term most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures. This is similar to an abrasion but more severe, as body parts such as an eyelid or an ear can be partially or fully detached from the body.

Burt Brent is a retired reconstructive plastic surgeon best known for his work in reconstructing the absent outer ear. He built upon the techniques of his mentor, Dr. Radford Tanzer of the Mary Hitchcock Clinic at Dartmouth Medical School and repaired ear defects in 1,800 patients, most of them children born with ear deformities such as microtia. He also reconstructed ears lost or due to some form of trauma.

Nasal reconstruction using a paramedian forehead flap is a surgical technique to reconstruct different kinds of nasal defects. In this operation a reconstructive surgeon uses skin from the forehead above the eyebrow and pivots it vertically to replace missing nasal tissue. Throughout history the technique has been modified and adjusted by many different surgeons and it has evolved to become a popular way of repairing nasal defects.

The tint of forehead skin so exactly matches that of the face and nose that it must be first choice. Is not the forehead the crowning feature of the face and important in expression? Why then should we jeopardize its beauty to make a nose? First, because in many instances, the forehead makes far and away the best nose. Second, with some plastic juggling, the forehead defect can be camouflaged effectively.

Flap (surgery) technique in plastic and reconstructive 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 distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. This is done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, or to rebuild more complex anatomic structures such as breast or jaw.

Scalp reconstruction is a surgical procedure for people with scalp defects. Scalp defects may be partial or full thickness and can be congenital or acquired. Because not all layers of the scalp are elastic and the scalp has a convex shape, the use of primary closure is limited. Sometimes the easiest way of closing the wound may not be the ideal or best way. The choice for a reconstruction depends on multiple factors, such as the defect itself, the patient characteristics and surgeon preference.

History of rhinoplasty

The history of rhinoplasty, began in antiquity. Surgical rhinoplasty began in ancient Egypt and ancient India. In India, it was developed by the ayurvedic physician Sushruta. Non-surgical rhinoplasty was a later development, with the history of non-surgical rhinoplasty occurring mainly in the 21st century.

References

  1. ABC of wound healing: BMJ 2006;332;710-712 Reconstructive surgery, D. E. Boyce, K. Shokrollahi
  2. sBMJ
  3. Orthop Clin North Am. 1993 Jul;24(3):393-409, The reconstructive ladder. An orthoplastic approach, L. Levin