Upton and Taghinia technique for type II cleft hand. A, Incisions within cleft are at juncture of glabrous and dorsal skin. B, Small trap door flap is used for commissure lining between ring and transposed index finger. Fibrous band is in contracted first web space. All neurovascular structures isolated on both sides of the index digit. C, Flap elevation provides wide exposure to entire palm, including the ring ray. Subperiosteal dissection and removal of long metacarpal. Intrinsic muscles exposed. D, Bipennate first dorsal interosseous muscle released from thumb and index ray transposed into long ray position at carpometacarpal level. E, Flaps are draped into new first web space and closed. Z-plasties and other local flaps can be used as appropriate. F, Final appearance. SEE TECHNIQUE 80.48