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We describe a modification of the cross finger flap procedure. The modification enhances the amount of soft tissue under the flap, permitting reconstruction of the nail bed where necessary. We present two clinical cases.

Toe-to-hand transfer is a well established procedure and is one of the best ways of reconstructing the missing fingers or parts of fingers. In congenital deformities of fingers and hands such as absence of digits, second toe transfer may create the grip function and is superior to all other procedures. We present three cases of four second toe transfer to reconstruct long finger defects after congenital malformations of the long fingers. The aim of this paper is to discuss some aspects of the procedure and to evaluate achieved results. All our four patients were operated on when they were over 10 years of age.

Anatomical examination of the blood-vessels in the distal phalanges of the foot show that the arteries and veins of this region are thick enough to be anastomosed by microsurgical means. This makes it possible to perform free toe-to-hand transfer, reconstructing defects of the distal phalanx and suturing arteries and veins at the level of the middle or even distal phalanxes. Eleven distal parts of the fingers have been reconstructed. All the transfers were successful, and good cosmetic and functional results were obtained.