Reconstructive surgery

doi:10.1136/bmj.332.7543.710

BMJ 2006;332:710-712 (25 March), doi:10.1136/bmj.332.7543.710

Practice

ABC of wound healing

Reconstructive surgery

Dean E Boyce, consultant hand and plastic surgeon, Kayvan Shokrollahi, specialist registrar in plastic surgery

Welsh Centre for Plastic Surgery, Morriston Hospital, Swansea.

The first 150 words of the full text of this article appear below.

Many surgical options are available to a reconstructive surgeonwhen faced with a difficult wound. However, any decision aboutmanagement should be holistic and take into account factorssuch as the occupational circumstances of the patient and likelyperiod of time off work, comorbidity, likelihood of success,donor morbidity, functional outcome, and the risks of surgeryand anaesthesia. The basic principles of wound management applyto all wounds.

The "reconstructive ladder"

Reconstructive surgeons use the concept of a "reconstructiveladder"—the more problematic the wound, the higher upthe ladder the surgeon has to climb. Simple wounds may be closedby primary suturing, sometimes in the primary care setting.But others may require complex reconstruction, including freetissue transfer, in hospital.

The "reconstructive ladder" is used by reconstructive surgeons to assess the complexity of treatment required

All traumatic wounds should undergo debridement and thoroughirrigation before primary closure. The aim of debridement isto . . . [Full text of this article]

Specific wounds

Pressure ulcers
Necrotising infections
Arterial ulcers
Diabetic foot ulcers
Pilonidal sinus and abscess
Non-melanoma skin cancer
Hidradenitis suppurativa