Another Dimension for the Choice in the Reconstructive Ladder, the Free Style Perforator Flap

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In the current era of modern reconstructive
surgery and the increased patient demands and
expectations, simple is not always the best and
reconstructive surgeons should choose the best
technique for the patient rather than the easiest
technique to be done. Therefore, in modern practice,
the surgeon can use free tissue transfer as a first
choice. Another example, in many reconstructive
operations in the authors' department, pedicled
freestyle perforator flaps were used successfully
as a first reconstructive option if primary closure
was not suitable.
Conclusions and Recommendations:
The addition of an independent rung for a pedicled
freestyle perforator flap would be a valuable
update to the reconstructive ladder. The reconstructive
Ladder better be viewed and re-arranged as
an order of the beneficial priority or advantage
rather than a classification of reconstructive options
from the simple towards the most complex. The
authors suggested a model of such modification,
and it is the same form of the reconstructive ladder
they use in their public hospital practice.
114 Vol. 47, No. 2 / Another Dimension for the Choice in the Reconstructive Ladder
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