Several congenital upper extremity anomalies may be treated using micro-surgical techniques. Long-term studies have shown the usefulness of microvascular toe transfer in the treatment of adactyly with the incorporation of the transferred digit into grasp-and-pinch function. The use of free fibular transfer for long bone deformities of the forearm has been shown to provide bony union as well as growth. Factors that must be considered include patient age, vessel availability, and lack of other possible reconstructive options.