TechniqueThe Second Toe-to-Hand Transfer for Full-length Thumb Reconstruction in Congenital Thumb’s Grade IIIb to V Hypoplasia: MTPJ Arthrodesis Instead of Tendon RebalansingOzols, Dzintars MD*,†,‡; Butnere, Marisa M. MD†,‡; Petersons, Aigars PhD†,‡Author Information *Department of Hand and Plastic Surgery, Microsurgery Centre of Latvia, Riga East University Hospital †Riga Stradins University ‡Children Clinical University Hospital, Riga, Latvia Approval No.16-A/14 has been received before study from university hospital ethical committee. Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding. Address correspondence and reprint requests to Dzintars Ozols, MD, Brivibas Avenue 410, 2nd floor, Riga 1024, Latvia. E-mail: email@example.com. Techniques in Hand & Upper Extremity Surgery: March 2020 - Volume 24 - Issue 1 - p 13-19 doi: 10.1097/BTH.0000000000000266 Buy Metrics Abstract Congenital thumb hypoplasia is a rare deformity of the upper extremity. The classification of thumb hypoplasia was created by Blauth in 1967 (types I to V). The base of the first metacarpal bone is absent for hypoplasia types IIIb to V, therefore, toe-to-hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for a successful toe-to-hand transplantation. The aim of this study is to describe a new technique for thumb reconstruction with the second toe transfer and metatarsophalangeal joint (MTPJ) arthrodesis, which can provide a five-digit hand and restore thumb functionality for thumb hypoplasia IIIb to V. We performed second toe-to-hand transplantation with MTPJ arthrodesis for 3 pediatric patients (mean age, 69 mo) with congenital thumb hypoplasia IIIb (n=2), grade V (n=1). Long-term follow-up evaluated the functions and esthetics of the hands for grade IIIb patients (n=2). We believe the second toe transfer with MTPJ arthrodesis transplantation is a promising method for reconstructing a full-length congenital or traumatic thumb absence for the pediatric population. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.