This case report documents a unique thumb reconstruction performed at the authors' institutions. The amputated dominant right thumb of a manual laborer was electively reconstructed with microvascular transfer of the previously partially amputated little finger from the same hand. At 1 year postoperatively, the patient returned to work with excellent grip and pinch strength, thumb opposition to all digits, and 8 mm of static two-point discrimination. The technical details of the operation are described and compared with other analogous reports in the literature.