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Ciclamini et al. Plast Aesthet Res 2023;10:62 Plastic and
DOI: 10.20517/2347-9264.2022.132
Aesthetic Research

Review Open Access

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

1
2
1
Davide Ciclamini , Leopoldo Arioli , Francesco Giacalone , Bruno Battiston 1 , Francesca Fissore 1
1
S.C. Orthopaedic and Traumatology II - Hand and Microsurgery Surgery Unit, AOU "Città della Salute e della Scienza di Torino",
Turin 10100, Italy.
2
“Sapienza” University of Rome - Orthopaedic and Traumatology Department of Sant’Andrea University Hospital, Rome 00189,
Italy
Correspondence to: Dr. Davide Ciclamini, S.C. Orthopaedic and Traumatology II - Hand and Microsurgery Surgery Unit, AOU
"Città della Salute e della Scienza di Torino", Via Zuretti 29, Turin 10100, Italy. E-mail: dciclamini@cittadellasalute.to.it
How to cite this article: Ciclamini D, Arioli L, Giacalone F, Battiston B, Fissore F. Principles of reconstruction. Like with like and
flap thinning: two essential tools. Plast Aesthet Res 2023;10:62. https://dx.doi.org/10.20517/2347-9264.2022.132

Received: 18 Nov 2022 Revised: 2 Oct 2023 Accepted: 30 Oct 2023 Published: 6 Nov 2023

Academic Editors: Raymund E. Horch, Adrian Dragu Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

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.

Keywords: Hand reconstruction, like-to-like flap, flap thinning

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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