Giant cell tumour (GCT) of bone is a benign but locally aggressive tumour. This connective tissue stromal tumour can recruit and interact with multinucleated giant cells with phenotypical characteristics of osteoclasts, leading to bony destruction. GCT that occurs in the metacarpal bones are often more aggressive and has a propensity to affect the first metacarpal bone. At the time of diagnosis, the tumour has usually breached the cortical bone. Recurrence rates are also higher in GCT of the first metacarpal bone, necessitating a wide resection to achieve tumour control. GCT affecting the first metacarpal bones poses a reconstructive complexity as preserving motion of the thumb carpometacarpal joint is paramount to maintain as much range of movement and function of the thumb. There is currently no described technique in the current literature that preserves motion in reconstructing the defect following tumour excision. We describe an innovative reconstructive option following excision of an entire first metacarpal bone for management of a giant cell tumour. The resultant defect was reconstructed with a vascularised rib graft. Early results of this technique suggest that it would be a good option for salvage of the native thumb, and longer term follow up results are required to assess the functional benefit of reconstructing a thumb metacarpal with a vascularised rib graft.