Miura and Komada reconstruction of cleft hand with adducted thumb. A, Initial skin incision on dorsum of hand. B, Additional incisions (broken line) to expose metacarpal dorsally and finger on palmar surface. C, Index finger skin flaps. D, Scheme for transposing index metacarpal to middle metacarpal position. E, Bone transposition: fasciae of first dorsal interosseous and adductor pollicis are released, and muscle may require release. F, Transposition of index and release of thumb completed. G, Appearance after wound closure. SEE TECHNIQUE 80.50.