Basic plastic surgery techniques and principles: Wound healing
In the fourth part of our series, Ben Taylor and Ardeshir Bayat explain the first few steps on the reconstructive ladder -- primary closure and skin grafts
Closing wounds and defects is a basic surgical skill. Plastic surgeons manage large, infected, or complex defects with a range of techniques; the idea of the “reconstructive ladder” is useful (fig 1). On the lower rungs are simple techniques; if these are not adequate, you can climb the ladder. As with real ladders, however, climbing too high too soon may be dangerous for your patient. Start at the bottom and consider each step carefully as you move up, until you have sufficient experience to know which rungs to jump.
The simplest way to treat a wound is to leave it to heal by secondary intention. This is not as uncaring as it sounds--our bodies evolved over millions of years to do this. Secondary intention allows the wound to drain and heal from the base up and is particularly appropriate for:
Even though you do not take measures to close the