Wound
closure
Wound closure can be achieved by number of
differing techniques. Most tidy wounds that do not involve loss of tissue can
be closed directly. Where there is tissue loss a technique to import appropriate
tissue is needed. Reconstructive plastic surgical techniques can range from
simple skin grafts to complex composite free tissue transfers (Table
3.1). This
list used to be described as a ‘reconstructive ladder’; unfortunately this
implies that the correct approach is to use the simplest technique and only when
it fails move to a more complex technique. This approach is not appropriate in
modern surgical practice. The available techniques should be regarded as a
‘toolbox’ from which to select the technique that provides most rapid
healing, earliest return to function and superior aesthetic outcome.