Pollicization of index finger is the main weapon in the hand of hand surgeons for aplasia and severe hypoplasia of the thumb. It is so popular method especially in the western world (Fig. 1, Fig. 2, Fig. 3).

However, the parents (including the grandparents) in the East Asia area are too stubborn to choose this method, they insist on maintaining the “useless floating thumb” always, even after the surgeon show them the “beautiful” pictures after pollicization, and introducing the advantages of the pollicization method in detail, such as it is a one-stage method and provides a very good function. Because of this cultural difference, we tried several methods in practice to reconstruct the first metacarpal and maintain the hypoplastic thumb, such as harvesting half metatarsal et al.

However, the good results were obtained in few cases. On account of this reason, we designed the composite second metatarso-cutaneous flap transfer for Type 3B/4 hypoplastic thumb from 2013. For the donor site, we used a half vascularized third metatarsal transfer to reconstruct the second metatarsal. The preliminary result is very good, no flap failure occurred. All parents are satisfied with both the appearance and the function of the new “thumb”. The complication at the donor site is minimal, foot function is almost normal.

Compare with the other traditional methods, second metatarso-cutaneous free flap is a kind of time-consuming and technique demanding procedure, however, according to our experiences, it is really a valuable method and a useful weapon in the armamentarium of the hand surgeons, especially in the East-Asia area.