Toe to Thumb Transfer is the best procedure. Gives excellent results, cosmesis excellent, function almost normal, one stage procedure. Disadvantages: loss of 2nd toe and requires a well trained, experienced microvascular surgeon.
2. Osteoplastic reconstruction is a multistaged, time consuming procedure giving very poor functional and cosmetic results. Could be considered if a micro surgeon is not available.
3. Distraction lengthening is second best after No. 1. Time and results depend upon lengthening to be achieved. Needs a skillful, trained surgeon.