We report the use of distraction lengthening of the middle phalanx after vascularized second toe transfer for middle finger reconstruction to lengthen the digit to match the index and ring fingers.MethodsWe performed a retrospective review of 3 patients with a mean follow-up of 30 months.ResultsA mean increase of 2.0 cm in the length in the digit was achieved. The range of motion at the proximal interphalangeal joint was preserved and bony union was seen at the distraction site in all 3 cases. All patients had an excellent functional and aesthetic outcome.ConclusionsDistraction lengthening of vascularized toe transfers is a feasible undertaking.Type of study/level of evidenceTherapeutic V.