To establish the surgical principles and techniques for aesthetic digit reconstruction with one stage second toe transfer.

One hundred male and 100 female volunteers with normal build from Qingdao area participated in the study. Their index fingers and second toes were photographed from different observation angles. Classification and measurements were made to provide a theoretical basis for aesthetic digit reconstruction with one stage second toe transfer. Since 2007, 57 fingers in 41 cases of finger defects were reconstructed with second toe transfer, based on the data measured and the type of the second toe. The 'take away the fat to fill in the thin' principle was adopted to take care of the aesthetic aspect while the digital vessels of the toe were anastomosed to the digital vessels of the finger for revascularization.

Fifty-six transferred toes survived, while 1 failed, with an overall 98.2% survival rate. Post-operative follow-up lasted for 6 months to 9 years. According to the assessment criteria for toe-to-hand transfer issued by IFSSH and Hand Surgery Society of Chinese Medical Association, 60.6% were excellent and 39.4% were good, with 100% satisfactory rate.

The principle of 'take away the fat’ from the pulp of the second toe to 'fill into the thin’ at the narrow section has been validated by follow-up results and should be acknowledged. The surgical principle and techniques for aesthetic digit reconstruction with one stage second toe transfer are relatively simple and achievable.

Microsurgery; Transplantation; Finger reconstruction; Aesthetic refinement