Reconstructive ladder or why does plastic surgery cost so much?

Reconstructive plastic surgeons use the concept of a reconstructive ladder to manage increasingly complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion and free flaps.

The ladder

There are several small variations in the reconstructive ladder in the scientific literature, but the principles remains the same:

Rung 1: Healing by secondary intention
Rung 2: Primary closure
Rung 3: Delayed primary closure
Rung 4: Split thickness graft
Rung 5: Full thickness skin graft
Rung 6: Tissue expansion
Rung 7: Random flap
Rung 8: Axial flap
Rung 9: Free flap