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Precourse 01: The Reconstructive Ladder

​Wednesday, October 2, 2013

7:30 – 11:30 AM

Moscone West 3014

Co-Chairs: Steven L. Moran, MD; Douglas P. Hanel, MD

Precourse Fees:

ASSH Member - $195
ASSH Senior Member - $145
Non-Member Surgeon - $225
Allied Health - $125
Resident/Fellow - $75

Includes printed & electronic syllabus.


The “reconstructive ladder” is a term used to describe the historic algorithm for the closure of soft tissue defects throughout the body.  The algorithm encourages one to start with the simplest solution for closure (primary closure) and then progress up the ladder to more complex solutions (free flaps); however recent advancements in our understanding of hand vascularity and anatomy have allowed hand surgeons to raise more complex flaps with confidence and reliability.  In addition new biologic products have allowed for the use of skin substitutes to facilitate and often obviate the need for complex wound closure.  This course will take a fresh look at the reconstructive ladder and how it relates to upper extremity surgery in 2013.   This course will use a case-based format and evidenced-based approach.  We will focus on techniques that are time tested in order to provide you with a practical approach to the management of soft tissue loss within the hand and fingers.

Learning Objectives:

At the conclusion of the program, participants will be able to:
  • Describe the options available for local flap coverage of the hand.
  • Understand where healing by secondary intention and skin substitutes are appropriate for wound coverage.
  • Be familiar with the use of the 1st dorsal metacarpal artery island flap, radial forearm flap, homodigital and heterodigital island flaps.
  • Describe the options available for elbow coverage.
Audience Level: (intermediate)
Keyword(s): Flaps, Skin grafts, free flaps, soft tissue coverage
CME: The ASSH designates this live activity for a maximum of 4.00 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The ASSH is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


Patrick Basile, MD
Brian T. Carlsen, MD
Jeffrey B. Friedrich, MD
Mark H. Henry, MD
James P. Higgins, MD
Neil F. Jones, MD
L. Scott Levin, MD, FACS
George P. Nanos, III, MD
Michael W. Neumeister, MD
William C. Pederson, MD, FACS
S. Raja Sabapathy, MS, MCh, DNB, FRCS
Milan V. Stevanovic, MD
View faculty financial relationship disclosures here


​7:30 ​Overview:  Wound evaluation and preparation ​Douglas P. Hanel, MD
​7:45 ​Healing by secondary intention and skin grafts: when and where ​Brian T. Carlsen, MD
​8:00 ​Skin substitutes: Where and when, what are the limits. ​Patrick Basile, MD
​8:15 ​Pedicled muscle flaps (Latissimus, FCU, anconeus) ​Jeffery B. Friedrich, MD
​8:30 ​Radial forearm and its variations ​Neil F. Jones, MD
​8:45 ​Pedicle flap reconstruction of finger defects ​Mark H. Henry, MD
​9:00 ​Thumb coverage (Moberg, 1st dorsal metacarpal) ​W. Chris Pederson, MD, FACS
​9:15 ​Special considerations around the elbow ​Steven L. Moran, MD
​9:30 ​Getting the most out of spare parts ​Michael W. Neumeister, MD
​9:45 ​Free flaps ALT, lateral arm and SCIP ​James P. Higgins, MD
​10:00 ​Distant pedicled flaps: Getting the most out of your groin flap ​S. Raja Sabapathy, MS, MCh, DNB, FRCS
​10:15 ​Composite defects (Bone and skin) ​Milan V. Stevanovic, MD
​10:30 ​Amputations: the ultimate coverage solution and how to prepare for the future reconstructive surgeries. ​George P. Nanos, III, MD
​10:45 ​When to consider functioning muscle/ CTA/ Prosthetics ​L. Scott Levin, MD, FACS
​11:00 ​Case presentation to panel and discussion ​Douglas P. Hanel, MD,
L. Scott Levin, MD, FACS,
James P. Higgins, MD,
George P. Nanos, III, MD,
Steven L. Moran, MD
​11:15 ​Questions

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