Technique of Nonvascularized Second Metacarpal Transfer in the Treatment of Symbrachydactyly

Various surgical techniques have been utilized for thumb reconstruction in the setting of aphalangia. Given abnormal proximal anatomy, nonvascularized toe phalangeal transfer has been a popular surgical technique in a subset of patients with monodactylous symbrachydactyly. However, altering the appearance of a noninvolved foot is often unappealing to many parents. Here we detail a surgical technique of thumb reconstruction utilizing the index metacarpal as a nonvascularized graft to improve thumb length and stability. This technique avoids the donor site morbidity associated with toe phalangeal transfer and has demonstrated good results at short-term follow-up.