Free vascularized joint transfers (VJT) are indicated for reconstruction of a composite defect of the finger joints. When the bone defect involves the proximal interphalangeal joint (PIPJ) and the full length of the middle phalanx, using the toe PIPJ with a shorter middle phalanx to reconstruct such a defect will be difficult. In this article, we describe an unusual application to repair the composite defect with a reversed inset of the toe PIPJ, where the proximal phalanx of the toe is placed distally and vice versa.
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