Lower limb reconstruction following trauma, chronic infection and cancer ablation remains challenging. However various options are now possible for lower limb reconstruction due to the more details available today about perforators. In recent years, the management of lower extremity has evolved with numerous new techniques and innovations and thus extremities are salvaged that would have been amputated in the past. Today we are able to cover various complex defects with the help of free flaps due to more of research and knowledge in this field which was previously unknown. In developed countries, all these procedures can be used because of the availability of good resources, good manpower, and the latest technologies. But in developing countries like India in spite of being aware of many of this methods, there is a limitation on using all these methods due to the limitation of resources, economic burden, limited manpower, and surgery time. The concept of the reconstructive ladder was proposed to achieve wounds with adequate closure using a stepladder approach from simple to complex procedures. The reconstructive elevator requires creative thoughts and consideration of multiple variables to achieve the best form and function rather than a sequential climb up the ladder. However, this paradigm of thought does not eliminate the concept of the reconstructive ladder but replaces it with a ladder of wound closure that makes its mark in the field where a variety of advanced reconstructive procedures and techniques is not readily available. Therefore the model of step ladder pattern of soft tissue defect management remains the good option for developing countries like ours. Also, various lower limb defects from simple to complex can be covered with simple methods rather than going for the most complex ones first. It helps in fast management and low economic burden to society with a lesser hospital stay.
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