Principles of reconstruction. Like with like and flap thinning: two essential tools

Abstract

The "like with like" and the "flap thinning" are two workhorse principles the surgeon must keep in mind to achieve a functional and cosmetic reconstruction of the hand. These principles are underpinned by a thorough knowledge of anatomy and functional hand units, with a wide range of reconstructive procedures that must be finalized to the necessity of the impaired structures. "Like with like" means that a lost tissue must be replaced with another one that can be compared in appearance and function. In addition, good cosmetic is often associated with good function because the complex attempt to get a proper aesthetic always traduces itself into a better functional reconstruction. "Flap thinning" is essential because soft tissue injuries of the hand represent a more difficult reconstructive challenge than similar injuries elsewhere, and the need for thin tissue to wrap the superficial noble structures of the hand is constant. However, the procedure of thinning a flap can be dangerous and must adhere to the vascular architecture of the flap. This paper aims to review and briefly summarize the current literature in this field.