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Reconstructive ladder

Writer: MaytaMayta
Mar 7, 20240 min read

Method

Description

Use Case

Primary Closure

Direct stitching of the wound edges together.

Small, clean wounds that can be easily brought together without tension.

Closure by Secondary Intention

The wound heals naturally without surgical closure.

Small wounds that can heal from the inside out, though it may result in larger scars and longer healing times.

Negative Pressure Wound Therapy (NPWT)

Uses a vacuum-sealed dressing to create negative pressure, promoting healing.

Wounds that benefit from reduced edema, increased blood flow, and stimulated granulation tissue formation.

Skin Graft

Transplanting skin from a donor site to the wound.

Wounds that cannot be closed directly but have a healthy enough bed to support a graft.

Dermal Matrices

Bioengineered scaffolds to replace or support the dermis.

Replacement or support of damaged or missing dermis, promoting cell regeneration.

Local Flaps

Tissue adjacent to the wound is used to cover the defect, keeping its blood supply.

Larger or more complex wounds where skin grafts might not be successful.

Regional Flaps

Tissue harvested from near the wound site, still connected to its blood supply, to cover defects.

Covering defects that cannot be closed by simpler means, utilizing nearby tissue segments.

Distant Flaps

Tissue from a different part of the body, transferred to the wound area.

Complex wounds not adjacent to usable tissue, requiring microvascular techniques to reattach blood vessels.

Free Flaps

The most complex method, transferring tissue along with its blood supply to the wound, requiring microvascular surgery.

Large or complex defects needing not just skin but possibly muscles, nerves, or bone reconstruction, especially when other methods are not viable.

Reconstructive ladder


 
 
 

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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