The new reconstructive ladder: modifications to the traditional model
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Updated: Jun 5, 2026
The Ladder Rung Walking Task: A Scoring System and its Practical Application.
Published on: June 12, 2009
Jeffrey E Janis1, Robert K Kwon, Christopher E Attinger
1Dallas, Texas; and Washington, D.C. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and the Departments of Plastic Surgery and Orthopedic Surgery, Georgetown University Medical Center.
Abstract:
The traditional reconstructive ladder has withstood the test of time, serving as a thought paradigm to guide surgeons in choosing their method of wound closure for an assortment of defects. Advances in anatomical understanding and technological innovations have improved our ability to achieve definitive closure in a wide variety of patients. In this article, the older construct is updated to reflect the use of negative-pressure wound therapy and dermal matrices. Perforator flap concepts are also discussed in terms of their inclusion as a rung on the ladder.
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