Brachydactyly simply means "short finger", but it has a clinical spectrum ranging from minor digital hypoplasia to complete aplasia. The index and small fingers are the most commonly affected digits, and the middle phalanx is the most commonly affected bone. Presentation of brachydactyly is highly variable-a digit may be just slightly shorter because of reduced growth of one phalanx or the metacarpal, or there may be complete absence of one or more phalanges, or there may be complete aplasia of the digit or multiple digits. This article discusses the results of conventional reconstruction using nonvascularized toe phalangeal bone grafting and distraction lengthening and the newer technique of microsurgical toe-to-hand transfers.