Reconstruction of central metacarpal ray defects of the hand with a free vascularized double metatarsal and metatarsophalangeal joint transfer

A massive central hand defect in a 12-year-old boy was reconstructed with a free vascularized tissue block including the second and third metatarsal bones, second metarsophalangeal joint, and common extensors of the second and third toes. Progressive bone growth has occurred and epiphyseal plates were still open at 12 months after transfer. Bone alignment and stabilization of the central hand were excellent. The foot is an excellent source of component spare parts for autogenous transfer to the hand.