Between 1988 and 1994 40 children (age range 9 months-14 years) with either congenital (85%) or acquired hand deformities underwent reconstruction by microvascular autotransplantation of one or more toes. Fourteen underwent a single toe transfer whilst 26 had two second toes transferred to one hand. In 14 of these cases both second toes were transferred at one operation. Whether one or two toes were transferred, the children spent on average 9 days in hospital. None of the transfers failed but 75% of the children underwent staged additional surgery to improve appearance and function. Thirty-seven of the 40 children attended with their parents for follow-up examination by an independent surgeon, a physiotherapist and a clinical psychologist in order to evaluate the results and consequences of surgery. This paper presents the technical considerations for this surgery and examines the influence of the transfer on growth.