Although simple "cookbook" treatment plans for most congenital hand problems are not possible, certain guiding principles should be followed. It is an important to identify when to operate as it is to know when not to operate. The timing of surgical interventions as well as the sequence of multistaged interventions play an important role in ultimate function of the hand. It may not always be possible to achieve both satisfactory power grasp and precision handling. Redistributing functional patterns that we have generally employed in our approach to traumatic injuries can be used in planning therapy for congenital malformations of the hand to try to achieve the best possible function with the available functioning anatomic parts.