Reconstructive Principles

After debridement it is obvious which layers of tissue and what structures are missing. Optimally, each layer of absent tissue should be repaired with like tissue, for example, the cutaneous defects should be closed with skin of similar thickness, color, and texture, cartilaginous defects should be repaired with a cartilaginous graft of similar characteristics.

The plastic surgeons armamentarium to cover defects is extensive: Defects can be closed by primary suture, partial- or full-thickness skin grafts, local flaps, regional flaps, or free flaps. Typically, the reconstruction begins with simple methods such as primary closure or skin grafts and progresses to local tissue, regional tissue reconstructions, and finally free tissue transfer. This reconstructive concept is described by the term reconstructive ladder which refers to an escalation from the simple to the most complex surgical option to achieve a successful reconstruction which is measured by an improvement in the patient's function, structure, and appearance. If a simple procedure serves this adequately it should be chosen, if not, the next step on the ladder should be evaluated.

However, in many patients the ideal approach requires skipping steps of the ladder and starting with the most complex option. A free flap may sometimes be the easiest technique to perform. Experience has confirmed that the complication rate of local flaps is similar to that of free flaps. Figure 17-1 gives an overview of the reconstructive ladder with examples.

Figure 17-1 Reconstructive ladder showing reconstructive principles and options for head and neck reconstruction.

Figure 17-1 Reconstructive ladder showing reconstructive principles and options for head and neck reconstruction.

0 0

Post a comment