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Ciclamini et al. Plast Aesthet Res 2023;10:62 https://dx.doi.org/10.20517/2347-9264.2022.132 Page 5 of 10

Figure 2. Evolution of venous flap postoperatively, day 1, day 10, and end of 3rd week.

Figure 3. Aesthetic and functional outcome of venous flap at 2 months after surgical procedure.

necessary for these reconstructions. We perform the separation of post-reconstructive syndactylies no
earlier than a year after the trauma, giving patients time to get used to the new hand. Patients often prefer to
keep syndactyly as they consider it a more functional hand [Figures 4 and 5]. Sensibility always remains the
main drawback in huge degloving injury reconstruction.

Dorsal aspect
The dorsal skin of the hand and fingers is hairy, thin, pliable, and extensile, allowing flexion and extension
of the fingers - the sensibility is no longer an issue. Thus, the surgeon must finalize the research of the ideal
tissue mainly to thinness (for aesthetic reasons) and extensibility (for functional reasons). Therefore, the
"like with like" principle gets far more manageable for the dorsal aspect. Skin grafts are not used here, except
for some selected cases (e.g., coverage of the donor site of a kite flap, or coverage of relatively small defects
[17]
where secondary graft retraction may not impair the extensor tendons gliding) CIT, due to the poor
aesthetic outcome and the risk of retraction, which is the main risk to be avoided. However, suppose a skin
graft has to be applied. In that case, dermal substitutes with an FTSK over a well-vascularized bed may be
helpful to minimize graft retraction and offer a thin reconstructive solution [Figure 6]. Deeper and larger
wounds require free flaps. As per extensive palmar reconstruction of degloving injuries, the ALT flap is
always too thick in Western people unless in very thin morphotypes. Therefore, ALT thinning during or