Thumb reconstruction. A, Failed thumb replantation after saw injury with concomitant primary ray amputation of index finger and partial amputation through middle finger. B–D, Metacarpophalangeal joint level thumb disarticulation and neurovascular island transfer of proximal phalanx segment of middle finger for thumb reconstruction. E, Radiographic appearance of transfer of middle finger proximal phalanx to thumb complex tissue. F, Example of functional hand use restored after sensory innervated composite thumb reconstruction.