The authors provide an excellent historical and current overview of the options for reconstruction of injuries of the thumb and finger tips. This takes you through the reconstructive ladder in its entirety, but also discusses philosophically the different approaches we as surgeons take, both within Europe and further afield. The technical nuances are addressed with a superb array of photographs and drawings to accompany the text. The article poses a number of questions about outcome. Which procedures actually provide the best for our patients? A simple enough question perhaps, but when there are a multitude of injuries, with various reconstruction options available, and limited outcome data, the answer remains an unknown!