The Evolution of Current Concept of the Reconstructive Ladder in Plastic Surgery: The Emerging Role of Translational Medicine

Abstract

Plastic surgeons have used the reconstructive ladder for many decades as a standard directory for complex trauma reconstruction with the goal of repairing body structures and restoring functionality. This consists of different surgical maneuvers, such as secondary intention and direct tissue closure, as well as more complex methods such as local tissue transfer and free flap. The reconstructive ladder represents widely known options achievable for tissue reconstruction and wound closure that puts at the bottom rung the simplest methods of reconstruction and strengthens the complexity by moving upward. Regenerative medicine and surgery constitute a quickly spreading area of translational research that can be employed by minimally invasive surgical strategies, with the aim of regenerating cells and tissues in vivo in order to reestablish normal function through the intrinsic potential of cells, in combination with biomaterials and appropriate biochemical stimuli. These translational procedures have the aim of creating an appropriate microenvironment capable of supporting the physiological cellular function to generate the desired cells or tissues and to generate parenchymal, stromal, and vascular components on demand, and above all to produce intelligent materials capable of determining the fate of cells. Smart technologies have been grown that give extra “rungs” on the classic reconstructive ladder to integrate a more holistic, patient-based approach with improved outcomes. This commentary presents the evolution of the traditional concept of the reconstructive ladder in the field of plastic surgery into a new course with the aim of achieving excellent results for soft tissue reconstruction by applying innovative technologies and biologically active molecules for a wide range of surgical diseases.

Pharyngeal reconstruction after total laryngectomy with sliding epiglottis: technical aspects with retrospective review

“…Herein-described epiglottis flap seems to represent an important technique for pharyngeal reconstruction after total laryngectomy; however, a few conditions have to be met before considering reconstruction with this local flap. As already mentioned, this technique can be appropriate when the primary closure, which is considered the first step of the reconstructive latter, is no longer feasible due to the lack of extra mucosal tissue ( 30 , 31 ). The pharyngoepiglottic folds have to be spared from the disease and also not resected as the ascending branch of the superior laryngeal artery runs towards the pharyngoepiglottic fold and supplies predominantly the ventral surface of the epiglottis ( 32 ).…”

Reconstructive Paradigms: A Problem-Solving Approach in Complex Tissue Defects

“…First described by Sir Harold Gillies, the concept of the “reconstructive ladder” was further popularized by Mathes and Nahai, allowing the surgeon to choose the procedure from simple to complex [ 11 , 12 ]. The reconstructive ladder established reconstructive priorities based on required technical complexity when approaching a defect or deformation, aiming to obtain the safest result for the patient [ 13 , 14 , 15 ]. Figure 1 displays the concept of the reconstructive ladder [ 16 , 17 ].…”

“…It is also applicable in various other contexts, such as pain management, inflammatory and chronic diseases, vascular disorders, post-cancer reconstruction and more. Additionally, translational medicine incorporates a range of advanced techniques, including the use of cell and tissue engineering scaffolds, a decellularized extracellular matrix, wearable medical devices, micro- and nanomedicine, 3D bioprinting, biomimetic engineering, organ-on-a-chip technologies, and bioelectronics [ 13 ].…”

Utilizing Low-cost Vacuum-assisted Closure as Adjuvant Therapy in Soft Tissue Reconstruction for a Mangled Upper Extremity

“…In these cases, the flap is prioritized to cover vital structures only. 3 Vacuum-assisted closure (VAC) has been used since 1997 for wound management, and its benefits have been widely published. [2][3][4] VAC affects four factors to accelerate wound healing: environment control, reduction of extracellular fluid, and macro and micro wound deformation.…”

“…3 Vacuum-assisted closure (VAC) has been used since 1997 for wound management, and its benefits have been widely published. [2][3][4] VAC affects four factors to accelerate wound healing: environment control, reduction of extracellular fluid, and macro and micro wound deformation. 5 However, the adoption of VAC, especially in developing countries, is limited due to the relatively high cost, not to mention the scarcity of available literature in reporting the use of VAC in mangled injuries.…”