Littler transfer of abductor digiti quinti to restore opposition. A, Two skin incisions. Intervening skin (shaded area) is undermined, creating pocket to receive transfer. B, Anatomy of abductor digiti quinti. Neurovascular bundle is located proximally on deep surface of muscle. Muscle inserts on proximal phalanx (1) and extensor tendon (2) of little finger. C, Origin of muscle is freed from pisiform but not from flexor carpi ulnaris tendon. Muscle is folded over about 170 degrees and is passed subcutaneously to thenar area, and its two tendons of insertion (1 and 2) are sutured to abductor pollicis brevis tendon.