Technology has dramatically altered paradigms and doctrines in modern medicine. In plastic surgery, there has been an explosion of medical knowledge and innovation resulting in a myriad of potential reconstructive options. Since the Edwin Smith Papyrus, treatment paradigms have facilitated the decision-making process of the reconstructive surgeon. In 1982, Mathes and Na-hai proposed the reconstructive ladder, which emerged as a very useful guiding framework for decision-making in plastic surgery. As one goes up the rungs of the ladder, an increasingly complex choice of surgical procedures is described to treat a specific problem. The surgeon should consider using the simplest procedure that effectively solves the problem.
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