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.