Tsuge ray reduction procedure. A, Fish-mouth incision made to the level of the proximal phalanx. B, Coronal osteotomy of the distal phalanx. C, Physis is removed by transverse osteotomy from remaining dorsal bone. Plantar portion is removed. D, Osteotomy and removal of dorsal middle phalanx. E, Dorsal third of distal phalanx is fixed to plantar two thirds of middle phalanx and tendons reattached. F, Fibrofatty tissue remains when digit is shortened, creating a dorsal bump. G, Excess tissue is debulked. (From Morrell NT, Fitzpatrick J, Szalay EA: The use of the Tsuge procedure for pedal macrodactyly: relevance in pediatric orthopaedics, J Pediatr Orthop B 23:260–265, 2014.) SEE TECHNIQUE 29.2.