The human thumb is crucial for hand function. With its unique ability to oppose the other fingers, it allows for precise grasping and manipulation of objects, making it essential for activities like writing, picking up small items, using tools, and performing complex hand movements. Traumatic amputation of the thumb is a functionally devastating injury for a patient, leading to a drastic reduction in quality of life. Over the last 120 years, considerable surgical efforts have been dedicated to reconstructing traumatic thumb amputations. In 1898 Nicolandi first described the pedicled transfer of a second to reconstruct the thumb in a five year old boy. This was a two-stage procedure involving toe transfer via a cross toe-to thumb flap, with division of the pedicle from the foot after 4 weeks. While novel, this procedure did not gain popularity due to the awkward positioning necessitated during the first stage, as well as poor functional outcomes. (1) In 1965, using microsurgical techniques, Buncke transferred the great toe to the thumb of a rhesus monkey. In 1969, Cobbett performed the first human toe-to-thumb transfer, transferring the great toe of a 31-year-old man with a traumatic thumb amputation. (1) Since then, techniques for toe to thumb transfers have evolved to minimise donor site morbidity and address a wider range of total and partial thumb amputations, including second toe transfers, wraparound to transfers and trimmed great toe transfers. They remain a gold standard option for microsurgical reconstruction of the amputated thumb. 1.Buncke GM, Buncke HJ, Lee CK. Great toe-to-thumb microvascular transplantation after traumatic amputation. Hand Clin. 2007. 23(1):105-115. doi:10.1016/j.hcl.2007.01.007