Wound closure and the reconstructive ladder in plastic surgery.

Wound closure requires deep understanding of wound physiology, anatomy, and the healing phase of the wound. The basic principles of wound closure, diabetes control, normal nutrition status, infection control, mechanical stress avoidance, and nursing care are all important elements in achieving healing of acute and chronic wounds. This goal is achievable only through the interdisciplinary approach to wound healing. A number of wound closure techniques are available to the plastic surgeon. This armamentarium includes a variety of techniques, from simple primary wound closure to more-sophisticated and -costly flap reconstructive techniques. This article summarizes the components of the reconstructive ladder for wound closure that are available to the reconstructive surgeon.