From 1977 to 1980, 21 second toes were transferred with microvascular anastomoses for congenital hand defects in 17 patients. There have been no vascular failures. Four thumbs were reconstructed with very good functional and cosmetic results. Active motion of the transplanted toe is limited, and the functional results depend on the mobility and musculature of the metacarpal remnant. Growth has been continuous and at least equal to the other toe. Cosmetic results have been very good. It is essential to distinguish between patients showing aplasia and those presenting amniotic band "amputation" syndrome. In the latter case, all structures are close to normal and the results are therefore better. Operative indications must be carefully appraised. If surgical intervention is decided upon, the ideal age is about 18 months, at which time the best integration of the toe is observed.