The thumb is a vital part of the hand. After traumatic loss of the thumb, hand function diminishes considerably. The loss of the great toe, on the other hand, although unsightly, is not a considerable functional loss to the foot. Aesthetic and functional losses are restored to the hand following great toe transplantation to the thumb position, with very little functional loss to the foot. Anatomic and operative details are discussed, along with preoperative and postoperative management. Postoperative functional evaluations of the thumb and donor site are assessed. Forty years of experience with this composite tissue transplantation has proven that great toe-to-thumb microvascular transplantation is the gold standard for thumb reconstruction after traumatic amputation.